Longitudinal growth during fetal life and infancy and cardiovascular outcomes at school-age

Toemen, Liza; Jonge, Layla L. de; Gishti, Olta; Osch-Gevers, Lennie van; Taal, H. Rob; Steegers, Eric A.P.; Hofman, Albert; Helbing, Willem A.; Jaddoe, Vincent W. V.

doi:10.1097/hjh.0000000000000947

Cited by 28 publications

(45 citation statements)

References 61 publications

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“…Longitudinal growth analysis suggests that children with higher BP tended to be smaller during third trimester of fetal life but were normal size as infants. By contrast, children with increased aortic root diameter or left ventricular mass tend to be larger during fetal life, but of similar size during infancy (Table 3) (54). School age children with clustering of CVD risk factors had a smaller first-trimester fetal crown-rump length, lower second and third trimester estimated fetal weight but more rapid growth from 6 months onward.…”

Section: Resultsmentioning

confidence: 99%

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

2017

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Physiologic adaptations during pregnancy unmask a woman’s predisposition to diseases. Complications are increasingly predicted by first-trimester algorithms, amplify a pre-existing maternal phenotype and accelerate risks for chronic diseases in the offspring up to adulthood (Barker hypothesis). Recent evidence suggests that vice versa, pregnancy diseases also indicate maternal and even grandparent’s risks for chronic diseases (reverse Barker hypothesis). Pub-Med and Embase were reviewed for Mesh terms “fetal programming” and “pregnancy complications combined with maternal disease” until January 2017. Studies linking pregnancy complications to future cardiovascular, metabolic, and thrombotic risks for mother and offspring were reviewed. Women with a history of miscarriage, fetal growth restriction, preeclampsia, preterm delivery, obesity, excessive gestational weight gain, gestational diabetes, subfertility, and thrombophilia more frequently demonstrate with echocardiographic abnormalities, higher fasting insulin, deviating lipids or clotting factors and show defective endothelial function. Thrombophilia hints to thrombotic risks in later life. Pregnancy abnormalities correlate with future cardiovascular and metabolic complications and earlier mortality. Conversely, women with a normal pregnancy have lower rates of subsequent diseases than the general female population creating the term: “Pregnancy as a window for future health.” Although the placenta works as a gatekeeper, many pregnancy complications may lead to sickness and earlier death in later life when the child becomes an adult. The epigenetic mechanisms and the mismatch between pre- and postnatal life have created the term “fetal origin of adult disease.” Up to now, the impact of cardiovascular, metabolic, or thrombotic risk profiles has been investigated separately for mother and child. In this manuscript, we strive to illustrate the consequences for both, fetus and mother within a cohesive perspective and thus try to demonstrate the complex interrelationship of genetics and epigenetics for long-term health of societies and future generations. Maternal–fetal medicine specialists should have a key role in the prevention of non-communicable diseases by implementing a framework for patient consultation and interdisciplinary networks. Health-care providers and policy makers should increasingly invest in a stratified primary prevention and follow-up to reduce the increasing number of manifest cardiovascular and metabolic diseases and to prevent waste of health-care resources.

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Section: Resultsmentioning

confidence: 99%

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

2017

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“…Additionally, the plane of nutrition during rehabilitation can influence the long‐term outcomes (Toemen et al . ). Thus, studies with animal models provide a means to isolate the role of individual factors.…”

Section: Discussionmentioning

confidence: 97%

“…; Toemen et al . ), no difference in children and adolescents (Jiang et al . ), or increases in adults (Arnott et al .…”

Section: Discussionmentioning

confidence: 99%

“…Anomalies of the coronary and general vasculature and haemodynamic parameters have been documented extensively, but less is known about the long-term effects on the heart. In humans, follow-up studies on the effects of IUGR on heart size or LV mass report positive correlations with birth weight (Hietalampi et al 2012;Toemen et al 2016), no difference in children and adolescents (Jiang et al 2006), or increases in adults (Arnott et al 2015). Adults born prematurely, and who probably experienced extrauterine growth retardation, have a larger LV mass and potentially pathological LV hypertrophy (Lewandowski et al 2013a).…”

Section: Discussionmentioning

confidence: 99%

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Postnatal undernutrition alters adult female mouse cardiac structure and function leading to limited exercise capacity

Ferguson

Monroe

Heredia

et al. 2019

The Journal of Physiology

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Key points Impaired growth during fetal life can reprogramme heart development and increase the risk for long‐term cardiovascular dysfunction. It is uncertain if the developmental window during which the heart is vulnerable to reprogramming as a result of inadequate nutrition extends into the postnatal period. We found that adult female mice that had been undernourished only from birth to 3 weeks of age had disproportionately smaller hearts compared to males, with thinner ventricle walls and more mononucleated cardiomyocytes. In females, but not males, cardiac diastolic function, and heart rate responsiveness to adrenergic stimulation were limited and maximal exercise capacity was compromised. These data suggest that the developmental window during which the heart is vulnerable to reprogramming by inadequacies in nutrient intake may extend into postnatal life and such individuals could be at increased risk for a cardiac event as a result of strenuous exercise. Abstract Adults who experienced undernutrition during critical windows of development are at increased risk for cardiovascular disease. The contribution of cardiac function to this increased disease risk is uncertain. We evaluated the effect of a short episode of postnatal undernutrition on cardiovascular function in mice at the whole animal, organ, and cellular levels. Pups born to control mouse dams were suckled from birth to postnatal day (PN) 21 on dams fed either a control (20% protein) or a low protein (8% protein) isocaloric diet. After PN21 offspring were fed the same control diet until adulthood. At PN70 V̇O2, max was measured by treadmill test. At PN80 cardiac function was evaluated by echocardiography and Doppler analysis at rest and following β‐adrenergic stimulation. Isolated cardiomyocyte nucleation and Ca2+ transients (with and without β‐adrenergic stimulation) were measured at PN90. Female mice that were undernourished and then refed (PUN), unlike male mice, had disproportionately smaller hearts and their exercise capacity, cardiac diastolic function, and heart rate responsiveness to adrenergic stimulation were limited. A reduced left ventricular end diastolic volume, impaired early filling, and decreased stored energy at the beginning of diastole contributed to these impairments. Female PUN mice had more mononucleated cardiomyocytes; under resting conditions binucleated cells had a functional profile suggestive of increased basal adrenergic activation. Thus, a brief episode of early postnatal undernutrition in the mouse can produce persistent changes to cardiac structure and function that limit exercise/functional capacity and thereby increase the risk for the development of a wide variety of cardiovascular morbidities.

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“…While the consequences for maternal and neonatal outcomes are well recognised, especially gestational diabetes and foetal macrosomia, the potential for longer-term impact on offspring health is not generally appreciated. Early Nutrition researchers, among others, have reported independent associations of maternal obesity, excessive weight gain, as well as diet in pregnancy with childhood adiposity and cardiovascular risk indicators [6,[52][53][54][55][56]. Because of these relationships and the well-established influences of micronutrient deficiencies on foetal development and childhood health, a focus on nutritional status in pregnancy is of paramount importance not only for the health of the mother, but also her offspring.…”

Section: Recommendations On Nutrition Of Pregnant Womenmentioning

confidence: 99%

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

et al. 2019

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Background: A considerable body of evidence accumulated especially during the last decade, demonstrating that early nutrition and lifestyle have long-term effects on later health and disease (“developmental or metabolic programming”). Methods: Researchers involved in the European Union funded international EarlyNutrition research project consolidated the scientific evidence base and existing recommendations to formulate consensus recommendations on nutrition and lifestyle before and during pregnancy, during infancy and early childhood that take long-term health impact into account. Systematic reviews were performed on published dietary guidelines, standards and recommendations, with special attention to long-term health consequences. In addition, systematic reviews of published systematic reviews on nutritional interventions or exposures in pregnancy and in infants and young children aged up to 3 years that describe effects on subsequent overweight, obesity and body composition were performed. Experts developed consensus recommendations incorporating the wide-ranging expertise from additional 33 stakeholders. Findings: Most current recommendations for pregnant women, particularly obese women, and for young children do not take long-term health consequences of early nutrition into account, although the available evidence for relevant consequences of lifestyle, diet and growth patterns in early life on later health and disease risk is strong. Interpretation: We present updated recommendations for optimized nutrition before and during pregnancy, during lactation, infancy and toddlerhood, with special reference to later health outcomes. These recommendations are developed for affluent populations, such as women and children in Europe, and should contribute to the primary prevention of obesity and associated non-communicable diseases.

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Longitudinal growth during fetal life and infancy and cardiovascular outcomes at school-age

Abstract: Specific fetal and infant growth patterns are associated with different cardiovascular outcomes in children. Further studies are needed to identify the underlying mechanisms and the long-term cardiovascular consequences.

Cited by 28 publications

References 61 publications

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

Postnatal undernutrition alters adult female mouse cardiac structure and function leading to limited exercise capacity

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

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