Association of Maternal Gestational Weight Gain With Left Ventricle Geometry and Function in Offspring at 4 Years of Age: A Prospective Birth Cohort Study

Wang, Jian; Du, Baigang; Wu, Yujian; Li, Zhuoyan; Chen, Qian; Zhang, Xi; Zhang, Lin; Ye, Yujiao; Wu, Yu; Sun, Chen; Kim, Sun

doi:10.3389/fped.2021.722385

Cited by 11 publications

(11 citation statements)

References 49 publications

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“…Five of thirteen (39%) articles excluded women with GDM. Two studies included women with diabetes, but the incidence of type 1 or 2 diabetes and GDM was not mentioned among women with obesity or controls [ 33 , 41 ]. Two other articles did not mention type 1 or 2 diabetes and GDM [ 31 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows the characteristics of the included studies. Six articles reported on outcomes in fetuses (n = 1483) [28][29][30][31][32][33], three articles on outcomes in neonates (n = 187) [34,35,39], three on outcomes in infants (children <1 year of age) (n = 234) [34][35][36] and three articles reported on outcomes in children older than 1 year of age (n = 6966) [38,40,41]. No articles reported on cardiac structure or function in adolescents or adults born to women with obesity.…”

Section: Plos Onementioning

confidence: 99%

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Maternal obesity in pregnancy and children’s cardiac function and structure: A systematic review and meta-analysis of evidence from human studies

et al. 2022

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The prevalence of obesity is increasing worldwide. Experimental animal studies demonstrate that maternal obesity during pregnancy directly affects cardiac structure and function in their offspring, which could contribute to their increased cardiovascular disease (CVD) risk. Currently, a systematic overview of the available evidence regarding maternal obesity and alterations in cardiac structure and function in human offspring is lacking. We systematically searched the electronic databases Embase, MEDLINE and NARCIS from inception to June 29, 2022 including human studies comparing cardiac structure and function from fetal life onwards in offspring of women with and without obesity. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (identifier: CRD42019125071). Risk of bias was assessed using a modified Newcastle-Ottawa scale. Results were expressed using standardized mean differences (SMD). The search yielded 1589 unique publications, of which thirteen articles were included. Compared to offspring of women without obesity, fetuses of women with obesity had lower left ventricular strain, indicative of reduced systolic function, that persisted in infancy (SMD -2.4, 95% confidence interval (CI) -4.4 standard deviation (SD) to -0.4 SD during fetal life and SMD -1.0, 95% CI -1.6 SD to -0.3 SD in infancy). Furthermore, infants born to women with obesity had a thicker interventricular septum (SMD 0.6 SD, 95% CI 0.0 to 1.2 SD) than children born to women without obesity. In conclusion, cardiac structure and function differs between fetuses and children of women with and without obesity. Some of these differences were present in fetal life, persisted in childhood and are consistent with increased CVD risk. Long-term follow-up research is warranted, as studies in offspring of older age are lacking.

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Section: Resultsmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Maternal obesity in pregnancy and children’s cardiac function and structure: A systematic review and meta-analysis of evidence from human studies

et al. 2022

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“…LV interventricular or posterior wall thickness, internal diameter, volume in systole and diastole (IVSs, IVSd, LVPWs, LVPWd, LVIDs, LVIDd, ESV and EDV), ejection fraction (LVEF), and shorten fraction (LVFS) were measured. Relative wall thickness (RWT), LV mass (LVM), LVM index (LVMI), E/A ratio, Tei index, and global peak longitudinal strain (GLS) were measured as previously described [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…The sex-specific 95th percentiles (P95th) of LVMI (male: 33.76 g/m 2.7 and female: 33.24 g/m 2.7 ) were derived from our own cohort. LV hypertrophy (LVH) was defined as LVMI ≥ the sex-specific P95th of LVMI [ 26 , 30 ]. All examinations were performed by experienced operators.…”

Section: Methodsmentioning

confidence: 99%

The association of gestational age and birthweight with blood pressure, cardiac structure, and function in 4 years old: a prospective birth cohort study

Wang

et al. 2023

BMC Med

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Background Current evidence relating birthweight and gestational age to cardiovascular risk is conflicting. Whether these factors have independent or interactive impacts on cardiovascular parameters during early childhood remains unclear. The goal of this study was to explore whether there were any independent and interactive effects of gestational age and birthweight on blood pressure, left ventricle (LV) structure, and function in 4 years old. Methods This study included 1194 children in the Shanghai Birth Cohort from 2013 to 2016. Information about the mothers and children was recorded at time of birth using a questionnaire. Follow-up measurements, including anthropometric, blood pressure, and echocardiography, were taken between 2018 and 2021, when the children were 4 years old. Multiple linear or logistic regressions and restricted cubic spline were used to explore the association of birthweight and gestational age with cardiovascular measurements. Results Gestational age had a significant negative correlation with both systolic blood pressure [β = − 0.41, 95% CI: (− 0.76, − 0.07)] and mean arterial pressure [β = − 0.36, 95%CI: (− 0.66, − 0.07)]. The risk of prehypertension decreased with increased gestational age [OR = 0.54, 95% CI: (0.32, 0.93)]. The relationship between birthweight with blood pressure was U-shape (P for non-linear < 0.001). The wall thickness, volume, mass, and cardiac output of LV increased with birthweight, though the ejection fraction [β = − 1.02, 95% CI: (− 1.76, − 0.27)] and shorten fraction [β = 0.72, 95% CI: (− 1.31, − 0.14)] decreased with birthweight. The risk of LV hypertrophy was not associated with birthweight [OR = 1.59, 95% CI: (0.68, 3.73)]. Conclusions In this study, we found different associations of birthweight and gestational age with cardiovascular measurements in the offspring at 4 years old. Gestational age influenced blood pressure independent of birthweight. Heart size and function at 4 years old was influenced mostly by birthweight and not by gestational age.

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“…Previous studies by our team have found intrauterine environmental exposure during pregnancy to be correlated with the development of fetal immune system, cardiovascular system, and physical capacity. [121][122][123][124] Excessive maternal weight gain during pregnancy, especially in the second and third trimesters, was associated with thickening of the interventricular septum and was a risk factor for left ventricular hypertrophy in children aged 4 years. [124] Children with a high birthweight had an increased risk of structural changes to the left ventricle at age 4 years, and boys had a higher risk of left ventricular hypertrophy, while girls did not.…”

Section: The Construction Of Our Translational Medicine Platformmentioning

confidence: 99%

The Construction of an Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease: Xinhua Hospital Model

Jiang

Wang

et al. 2023

Cardiology Discovery

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With the growing influence of slow population growth and population aging, China has established the birth policy and issued a series of documents to promote maternal and fetal health and improve the birth rate. With the increase in prevalence of birth defects, timely diagnosis and intervention in utero provide possibilities to reduce unnecessary abortions and offer better prognosis. Congenital heart disease (CHD), as one of the most common congenital birth defects, is the leading cause of mortality in patients aged <5 years, and brings a heavy burden to both the affected families and society. Fetuses with CHD are associated with an increased risk of pregnancy-related complications and premature birth, and children with CHD typically face growth and developmental problems even after the correction of malformation. Therefore, management including diagnosis, treatment, and rehabilitation throughout the fetal period into childhood and even adulthood is essential for children with CHD. Based on the rapid advances in intrauterine and perinatal medicine and an in-depth collaboration among obstetrics and pediatrics, a novel diagnosis and treatment system has been established for the management of CHD in the past 2 decades in Shanghai Xinhua Hospital. This Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease model provides prenatal diagnosis, intrauterine intervention, delivery room service and neonatal therapies, and postintrauterine rehabilitation for children with CHD. We have developed a four-dimensional spatiotemporal image correlation echocardiography and a three-dimensional cardiac virtual endoscopy system for the intrauterine diagnosis of CHD, dramatically raising the diagnostic utility. Our innovative and independent newborn-intervention technique has effectively reduced the re-intervention rate in patients with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. In 2018, Xinhua Hospital independently performed the case of fetal aortic valvuloplasty in Asia through a multidepartment collaborative effort. All children treated in this system achieved biventricular circulation and a better long-term postoperative outcome. We also have conducted postoperative rehabilitation therapy to promote the development and health of children with CHD. The practice of Xinhua model has reduced unnecessary abortion of CHD fetuses, reduced the mortality rate associated with critical CHD, and improved the mid- and long-term prognosis in CHD, which is essential to promote the fertility level and children’s health. Furthermore, translational medicine platform and the birth cohort Early Life Plan was constructed to explore the origins of major developmental diseases and establish an early intervention model in CHD. This practice of assessment of the intrauterine system has been expanded to other congenital defects in Xinhua Hospital, and sequential treatment of more than 2,000 cases has been completed to date. Based on practice in intrauterine management of CHD and other diseases, the concept of Intrauterine Pediatrics was proposed as a first to emphasize early prevention and intervention of childhood diseases and promote a comprehensive lifecycle service for children. The development and evolution of this system requires further attention not only from researchers but also from the government and global medical communities.

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Association of Maternal Gestational Weight Gain With Left Ventricle Geometry and Function in Offspring at 4 Years of Age: A Prospective Birth Cohort Study

Cited by 11 publications

References 49 publications

Maternal obesity in pregnancy and children’s cardiac function and structure: A systematic review and meta-analysis of evidence from human studies

Maternal obesity in pregnancy and children’s cardiac function and structure: A systematic review and meta-analysis of evidence from human studies

The association of gestational age and birthweight with blood pressure, cardiac structure, and function in 4 years old: a prospective birth cohort study

The Construction of an Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease: Xinhua Hospital Model

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