Cardiac structures track during the first 2 years of life and are associated with fetal growth and hemodynamics: the Generation R Study

Am Heart J. 2009 Jul;158(1):71-7. doi: 10.1016/j.ahj.2009.04.018.


Background: The aim of this study is to examine whether cardiac size and function track in early childhood and are associated with fetal and early postnatal growth and blood flow characteristics.

Methods: This study was embedded in a population-based prospective cohort study from fetal life onward. Fetal growth and fetal and placental blood flow parameters in second and third trimester of pregnancy were measured by ultrasound and Doppler. Left cardiac structures and shortening fraction were measured postnatally at the ages of 1.5, 6, and 24 months. Analyses were based on 1,001 children.

Results: Left ventricular mass tended to remain in the lowest and highest quartiles from the age of 1.5 to 24 months (odds ratio 1.70, 95% confidence interval [CI] 1.10-2.63) and 2.15 (95% CI 1.41-3.30), respectively. Similar results were found for aortic root diameter and left atrial diameter. Birth weight was positively associated with aortic root diameter (0.08 mm, 95% CI 0.01-0.17; per SD increase) and left ventricular mass (0.65 g, 95% CI 0.09-1.21; per SD increase). Resistance indices of the umbilical and uterine arteries showed weak tendencies toward inverse associations with left cardiac structures. Fetal cardiac output was positively associated with both left atrial diameter (increase of 1.96 mm, 95% CI 1.28-2.64; per mL/min increase) and left ventricular mass (increase of 1.79 g, 95% CI 0.35-3.22; per mL/min increase).

Conclusions: This study suggest moderate tracking of left cardiac structures during the first 2 years and that small size and hemodynamic variations in fetal life have consequences for postnatal cardiac size and function.

MeSH terms

  • Aorta, Thoracic / diagnostic imaging
  • Cardiac Volume / physiology*
  • Child, Preschool
  • Cohort Studies
  • Echocardiography*
  • Echocardiography, Doppler
  • Female
  • Fetal Development / physiology*
  • Health Surveys
  • Heart Atria / diagnostic imaging
  • Heart Ventricles / diagnostic imaging
  • Hemodynamics / physiology*
  • Humans
  • Hypertrophy, Left Ventricular / congenital
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Infant
  • Infant, Newborn
  • Male
  • Myocardial Contraction / physiology*
  • Placental Circulation / physiology
  • Pregnancy
  • Pregnancy Trimester, Third
  • Prospective Studies
  • Risk Factors
  • Ultrasonography, Doppler*
  • Ultrasonography, Prenatal*
  • Ventricular Function, Left / physiology*