Fetal programming as a predictor of adult health or disease: the need to reevaluate fetal heart function

Abstract

Epidemiologic and experimental evidence suggests that adverse stimuli during critical periods in utero permanently alters organ structure and function and may have persistent consequences for the long-term health of the offspring. Fetal hypoxia, maternal malnutrition, or ventricular overloading are among the major adverse conditions that can compromise cardiovascular development in early life. With the heart as a central organ in fetal adaptive mechanisms, a deeper understanding of the fetal cardiovascular physiology and of the echocardiographic tools to assess both normal and stressed pregnancies would give precious information on fetal well-being and hopefully may help in early identification of special risk groups for cardiovascular diseases later in life. Assessment of cardiac function in the fetus represents an additional challenge when comparing to children and adults, requiring advanced training and a critical approach to properly acquire and interpret functional parameters. This review summarizes the basic fetal cardiovascular physiology and the main differences from the mature postnatal circulation, provides an overview of the particularities of echocardiographic evaluation in the fetus, and finally proposes an integrated view of in utero programming of cardiovascular diseases later in life, highlighting priorities for future clinical research.

Chronically Hypoxic Fetal Lambs Supported by an Extra-Uterine Device Exhibit Mitochondrial Dysfunction and Elevations of Hypoxia Inducible Factor 1-Alpha

“…Not only can in utero hypoxia have devastating effects on the developing fetus, but it can also induce secondary neonatal complications and predispose the infant to the development of several chronic diseases later in life Fetal Diagn Ther 2019;45:176-183 DOI: 10.1159/000488283 [1][2][3]. Currently, there is no effective treatment for fetal hypoxia apart from early delivery, which carries associated risks of prematurity.…”

Next-generation pacemakers: from small devices to biological pacemakers

“…Humans can be born alive without many of the major organs, but the heart is indispensable for the embryo to progress beyond 10 weeks of gestation 1 . Even with an anatomically normal heart, an insufficient rate of contraction is highly lethal: untreated congenital heart block portends a fetal mortality of ~80% 2 .…”

Prognostic Factors of Successful Cervical Ripening and Labor Induction in Late-Onset Fetal Growth Restriction

“…CS, cesarean section; EFW, estimated fetal weight; UA, umbilical artery; MCA, middle cerebral artery; CPR, cerebro-placental ratio; NICU, neonatal intensive care unit; PI, pulsatility index; SD, standard deviation. 1 Obtained at the last scan, performed within 7 days of delivery. pared to the CS group.…”

“…Excluding congenital anomalies, it is usually a consequence of a mismatch between fetal nutritional needs and placental supply. It is associated with a higher rate of perinatal and long-term morbidity and mortality [1]. Lateonset FGR refers to those diagnosed beyond 32 weeks [2] and affects 3-5% of pregnancies in our setting [3].…”