Fetal/infant growth patterns and early markers of arterial health

“Previous studies suggest that altered growth patterns in fetal life and infancy are related to increased risks of cardiovascular diseases in adulthood,” said leading investigator Romy Gonçalves, MSc, who is a PhD candidate in pediatric epidemiology at Erasmus MC, University Medical Center in Rotterdam, the Netherlands. “For example, low birth weight is associated with an unfavorable body composition, higher blood pressure, and higher levels of cholesterol and triglycerides.”

Carotid intima-media thickness and carotid distensibility can both be measured by ultrasound. “The intima-media thickness reflects the inner and middle layer of an artery, and plaque buildup can be identified this way,” Gonçalves told Contemporary OB/GYN.

Arterial distensibility reflects the elasticity of an artery, according to Gonçalves. “Decreased distensibility is associated with increased risk of arterial wall damage,” she said. “In adults, suboptimal quality of the carotid artery, such as increased carotid intima-media thickness and reduced carotid distensibility, is related to the development of atherosclerosis and cardiovascular diseases. However, this relationship is less clear in children.”

The population-based prospective cohort study was conducted from early fetal life onward in 4,484 offspring (50.4% girls and 57.5% Dutch ethnicity) of women in Rotterdam, the Netherlands, delivering between April 2002 and January 2006.

Estimated fetal weight was measured in the second and third trimester, whereas infant weight was measured at 6, 12 and 24 months.

Follow-up measurements were available for the children at a median age of 9.7 years.

Gestational age at birth was not associated with markers of arterial health; however, a 500 g higher birth weight was linked to significantly increased carotid intima-media thickness and a lower carotid distensibility.

Compared to children with a birth weight of 2500 g to 4500 g, those weighing more than 4500 g had the lowest carotid distensibility.

In addition, compared to children with normal fetal and infant growth, children with normal fetal growth that was followed by accelerated infant growth had the highest carotid intima-media thickness.

The observed associations were mostly explained by childhood body mass index (BMI).

“We hypothesized that children born with low or high birth weight would have increased carotid intima-media thickness and lower carotid distensibility,” Gonçalves said. “But we did not find associations of low birth weight with arterial health.”

The relations of higher fetal weight and infant weight growth with arterial health outcomes are quite novel and indicate that very early-in-life increased weight gain has an effect on the carotid intima-media thickness and carotid distensibility, according to Gonçalves. “Our results suggest that high birth weight followed by higher infant and childhood weight gain is associated with an increased risk of adverse arterial health,” she said.

Gonçalves said further research is needed to examine the extent that adverse arterial health in childhood persists into adulthood. “Our outcomes imply that optimizing growth in early life might be beneficial for arterial health in later life,” she said. “Because our results were partly explained by childhood BMI, preventing high infant weight gain and childhood obesity could aid in reducing adverse arterial health.”

Exemplary prenatal care and information for caregivers and parents on reducing excessive infant weight gain could aid in reducing childhood obesity and subsequent cardiovascular diseases.

“I believe further studies should focus on longitudinal carotid measurements and determining if adverse childhood arterial health persists into adulthood,” Gonçalves said. “Thereby, it could be determined if measurements of childhood arterial health might add to prevention strategies to improve cardiovascular health later in life.”

Reference

1. Gonçalves R, Wiertsema CJ, Silva CCV, et al. Associations of fetal and infant growth patterns with early markers of arterial health in school-aged children. JAMA Netw Open. Published online June 29, 2022. doi:10.1001/jamanetworkopen.2022.19225