Antenatal hemodynamic findings and heart rate variability in early school-age children born with fetal growth restriction

Abstract

Background

According to epidemiological studies, impaired intrauterine growth increases the risk for cardiovascular morbidity and mortality in adulthood. Heart rate variability (HRV), which reflects the autonomic nervous system function, has been used for risk assessment in adults while its dysfunction has been linked to poor cardiovascular outcome.

Objective

We hypothesized that children who were born with fetal growth restriction (FGR) and antenatal blood flow redistribution have decreased HRV at early school age compared to their gestational age matched peers with normal intrauterine growth.

Study design

A prospectively collected cohort of children born with FGR (birth weight <10th percentile and/or abnormal umbilical artery flow, n = 28) underwent a 24-hour Holter monitoring at the mean age of 9 years and gestational age matched children with birth weight appropriate for gestational age (AGA, n = 19) served as controls. Time- and frequency domain HRV indices were measured and their associations with antenatal hemodynamic changes were analyzed.

Results

Time- and frequency domain HRV parameters (standard deviation of R–R intervals, SDNN; low frequency, LF; high frequency, HF; LF/HF; very low frequency, VLF) did not differ significantly between FGR and AGA groups born between 24 and 40 weeks. Neither did they differ between children born with FGR and normal umbilical artery pulsatility or increased umbilical artery pulsatility. In total, 56% of the FGR children demonstrated blood flow redistribution (cerebroplacental ratio, CPR < −2 SD) during fetal life and their SDNN (p = .01), HF (p = .03) and VLF (p = .03) values were significantly lower than in FGR children with CPR ≥ −2SD.

Conclusions

Early school age children born with FGR and intrauterine blood flow redistribution demonstrated altered heart rate variability. These prenatal and postnatal findings may be helpful in targeting preventive cardiovascular measures in FGR.

Keywords:

• Catch-up growth
• cerebroplacental ratio
• heart rate variability
• placental insufficiency
• umbilical artery

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Alma och K.A. Snellman Foundation (NK), the Instrumentarium Foundation under [grant 180014 (NK)]; the Finnish Cultural Foundation under [grant 00180555] (NK) and Oulu University Health and Biosciences Doctoral Program (NK).