Remodeling of the cardiovascular circulation in fetuses of mothers with diabetes: A fetal computational model analysis

Kulkarni, Aparna; García-Cañadilla, Patricia; Khan, Abdullah; Lorenzo, Jose Miguel Mateo D; Beckerman, Karen; Valenzuela-Alcaráz, Brenda; Cruz‐Lemini, M.; Gómez, O.; Gratacós, Eduard; Crispi, F.; Bijnens, Bart

doi:10.1016/j.placenta.2017.12.020

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…Models that impose a prescribed pressure or flow profile obtain this profile either by a simple function [e.g., ( 80 , 82 , 92 )] or from patient data [e.g., ( 74 , 76 )]. When using patient data, the prescribed pressure or flow profile could be used to find parametric differences between healthy and pathological cases by fitting the suspected influenced parameters to the prescribed profile ( 75 – 77 ). In addition, a patient-specific model can be obtained when using measured blood velocity profiles ( 74 ).…”

Section: Discussionmentioning

confidence: 99%

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A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system

et al. 2022

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BackgroundPreterm birth is the main cause of neonatal deaths with increasing mortality and morbidity rates with decreasing GA at time of birth. Currently, premature infants are treated in neonatal intensive care units to support further development. However, the organs of, especially, extremely premature infants (born before 28 weeks of GA) are not mature enough to function optimally outside the womb. This is seen as the main cause of the high morbidity and mortality rates in this group. A liquid-filled incubator, a so-called PLS system, could potentially improve these numbers for extremely premature infants, since this system is designed to mimic the environment of the natural womb. To support the development and implementation of such a complex system and to interpret vital signals of the fetus during a PLS system operation, a digital twin is proposed. This mathematical model is connected with a manikin representing the digital and physical twin of the real-life PLS system. Before developing a digital twin of a fetus in a PLS system, its functional and technical requirements are defined and existing mathematical models are evaluated.Method and resultsThis review summarizes existing 0D and 1D fetal circulatory models that potentially could be (partly) adopted for integration in a digital twin of a fetus in a PLS system based on predefined requirements. The 0D models typically describe hemodynamics and/or oxygen transport during specific events, such as the transition from fetus to neonate. Furthermore, these models can be used to find hemodynamic differences between healthy and pathological physiological states. Rather than giving a global description of an entire cardiovascular system, some studies focus on specific organs or vessels. In order to analyze pressure and flow wave profiles in the cardiovascular system, transmission line or 1D models are used. As for now, these models do not include oxygen transport.ConclusionThis study shows that none of the models identified in literature meet all the requirements relevant for a digital twin of a fetus in a PLS system. Nevertheless, it does show the potential to develop this digital twin by integrating (parts) of models into a single model.

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Section: Discussionmentioning

confidence: 99%

“…The parameters of this model are first tuned to mimic healthy fetuses and subsequently verified on fetuses with fetal growth restriction ( 75 , 76 ). In addition, this model has been used to evaluate the differences of fetal hemodynamics from diabetic and non-diabetic mothers ( 77 ).…”

Section: Fetal Circulatory Modelsmentioning

confidence: 99%

A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system

et al. 2022

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“…Several of this mechanism have been postulated and include fetal growth restriction, preeclampsia, preterm birth, assist reproductive technology (ART), exposure to toxic drugs, twin-to-twin transfusion syndrome (TTTS) and maternal diabetes and obesity. Evidence suggests that ART induces alterations in cardiac and vascular morphology and physiology ( 2 – 5 ). In this collection, Li et al , conducted a comprehensive review of epigenetic mechanisms associated with an increased risk of cardiovascular disease (CVD) in offspring conceived via ART.…”

Section: Fetal Cardiovascular Remodeling and Post-natal Cardiac Functionmentioning

confidence: 99%

Editorial: Rising stars in pediatric cardiology 2023

Sun,

Muiño-Mosquera

2024

Front. Pediatr.

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“…These findings highlighted an essential mechanism of fetal circulatory adaption in IUGR patients. Similarly, the ultrasound-derived LPNs of fetuses whose mothers had diabetes mellitus (FMDMs) showed that placental resistance and cerebral artery diameters significantly decreased, while cerebral vascular resistance and aortic diameter significantly increased [ 136 ] when compared to healthy fetuses, with differences exacerbated by increased gestational stage. The morphological and hemodynamic changes uncovered through the LPN correlate with enhanced placental flow and reduced cerebral flow, suggesting a mechanism for why FMDMs tend to have an enlarged placenta and underdeveloped brain.…”

Section: Lumped Parameter Models Of Fetal Circulationmentioning

confidence: 99%

“…The validation of fetal hemodynamic simulation results is key to their accuracy and reliability. As with pediatric and adult simulations, fetal simulation results are typically validated using in vitro or in vivo (Doppler) measurements and comparisons [ 133 , 134 , 135 , 136 , 141 , 142 , 170 ]. While Doppler measurements are excellent for reduced-order model validation, 3D simulations may benefit from more extensive spatial validation.…”

Section: Concluding Remarks and Future Directionsmentioning

confidence: 99%

Recasting Current Knowledge of Human Fetal Circulation: The Importance of Computational Models

Zhang

Lindsey

2023

JCDD

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Computational hemodynamic simulations are becoming increasingly important for cardiovascular research and clinical practice, yet incorporating numerical simulations of human fetal circulation is relatively underutilized and underdeveloped. The fetus possesses unique vascular shunts to appropriately distribute oxygen and nutrients acquired from the placenta, adding complexity and adaptability to blood flow patterns within the fetal vascular network. Perturbations to fetal circulation compromise fetal growth and trigger the abnormal cardiovascular remodeling that underlies congenital heart defects. Computational modeling can be used to elucidate complex blood flow patterns in the fetal circulatory system for normal versus abnormal development. We present an overview of fetal cardiovascular physiology and its evolution from being investigated with invasive experiments and primitive imaging techniques to advanced imaging (4D MRI and ultrasound) and computational modeling. We introduce the theoretical backgrounds of both lumped-parameter networks and three-dimensional computational fluid dynamic simulations of the cardiovascular system. We subsequently summarize existing modeling studies of human fetal circulation along with their limitations and challenges. Finally, we highlight opportunities for improved fetal circulation models.

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Remodeling of the cardiovascular circulation in fetuses of mothers with diabetes: A fetal computational model analysis

Abstract: Blood flow is redistributed in FMDM to the placenta, away from the brain. This alteration may play a role in the postnatal health of these fetuses.

Cited by 3 publications

References 24 publications

A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system

A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system

Editorial: Rising stars in pediatric cardiology 2023

Recasting Current Knowledge of Human Fetal Circulation: The Importance of Computational Models

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