Intrauterine Growth Restriction: New Insight from the Metabolomic Approach

Abstract

Recognizing intrauterine growth restriction (IUGR) is a matter of great concern because this condition can significantly affect the newborn’s short- and long-term health. Ever since the first suggestion of the “thrifty phenotype hypothesis” in the last decade of the 20th century, a number of studies have confirmed the association between low birth weight and cardiometabolic syndrome later in life. During intrauterine life, the growth-restricted fetus makes a number of hemodynamic, metabolic, and hormonal adjustments to cope with the adverse uterine environment, and these changes may become permanent and irreversible. Despite advances in our knowledge of IUGR newborns, biomarkers capable of identifying this condition early on, and stratifying its severity both pre- and postnatally, are still lacking. We are also still unsure about these babies’ trajectory of postnatal growth and their specific nutritional requirements with a view to preventing, or at least limiting, long-term complications. In this setting, untargeted metabolomics—a relatively new field of ‘-omics’ research—can be a good way to investigate the metabolic perturbations typically associated with IUGR. The aim of this narrative review is to provide a general overview of the pathophysiological and clinical aspects of IUGR, focusing on evidence emerging from metabolomic studies. Though still only preliminary, the reports emerging so far suggest an “early” pattern of glucose intolerance, insulin resistance, catabolite accumulation, and altered amino acid metabolism in IUGR neonates. Further, larger studies are needed to confirm these results and judge their applicability to clinical practice.

Insights into intrauterine growth restriction based on maternal and umbilical cord blood metabolomics

“…Controversial information is evidenced in the literature concerning candidate metabolites for IUGR-AGA discrimination, with abnormal amino acid metabolism, glucose intolerance and limited insulin resistance being an important finding 19 .…”

How could metabolomics change pediatric health?

“…Recent metabolomics results in IUGR [5,47], even in relation to gut dysbiosis [48] and evaluating neonatal urines [49,50], and in GDM [51][52][53] are currently available in literature.…”

Metabolomics Applications in Children: A Right Way to Go

“…An interesting review [ 4 ] showed that metabolomic studies regarding the IUGR condition clearly differentiate between IUGR babies and controls and, despite all limitations, suggest an “early” pattern of glucose intolerance, insulin resistance, catabolite accumulation, disrupted amino acid metabolism and abnormal fetal liver function.…”