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Impact of overweight and obesity in the fetal cardiac function parameters in the second and third trimesters of pregnancy

Published online by Cambridge University Press:  06 July 2023

Alberto Borges Peixoto ,
Nathalie Jeanne Bravo-Valenzuela Open the ORCID record for Nathalie Jeanne Bravo-Valenzuela [Opens in a new window] ,
Wellington P. Martins ,
Gabriele Tonni ,
Antonio Fernandes Moron ,
Rosiane Mattar ,
Rodrigo Ruano ,
Liliam Cristine Rolo  and
Edward Araujo Júnior Open the ORCID record for Edward Araujo Júnior [Opens in a new window]
Alberto Borges Peixoto
Affiliation:
Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil. Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
Nathalie Jeanne Bravo-Valenzuela
Affiliation:
Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
Wellington P. Martins
Affiliation:
SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto-SP, Brazil
Gabriele Tonni
Affiliation:
Department of Obstetrics and Neonatology, Prenatal Diagnostic Centre, Istituto di Cura e Ricovero a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
Antonio Fernandes Moron
Affiliation:
Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
Rosiane Mattar
Affiliation:
Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
Rodrigo Ruano
Affiliation:
Department of Maternal and Fetal Medicine, Fetal Surgery Service, Obstetrics and GynecologyUniversity of Miami, Miller School of Medicine, Miami, Fl, USA
Liliam Cristine Rolo
Affiliation:
Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
Edward Araujo Júnior*
Affiliation:
Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
*
Corresponding author: E. Araujo Júnior; Email: araujojred@terra.com.br
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Abstract

Objective:

To assess the impact of overweight and obesity in the second and third trimesters of pregnancy on fetal cardiac function parameters.

Methods:

We performed a prospective cohort study of 374 singleton pregnant women between 20w0d and 36w6d divided into three groups: 154 controls (body mass index - BMI < 25 kg/m2), 140 overweight (BMI 25–30 kg/m2) and 80 obese (BMI ≥ 30 kg/m2). Fetal left ventricular (LV) modified myocardial performance index (Mod-MPI) was calculated according to the following formula: (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Spectral tissue Doppler was used to determine LV and right ventricular (RV) myocardial performance index (MPI'), peak myocardial velocity during systole (S'), early diastole (E'), and late diastole (A').

Results:

We found significant differences between the groups in maternal age (p < 0.001), maternal weight (p < 0.001), BMI (p < 0.001), number of pregnancies (p < 0.001), parity (p < 0.001), gestational age (p = 0.013), and estimated fetal weight (p = 0.003). Overweight pregnant women had higher LV Mod-MPI (0.046 versus 0.044 seconds, p = 0.009) and LV MPI' (0.50 versus 0.47 seconds, p < 0.001) than the control group. Obese pregnant women had higher RV E' than control (6.82 versus 6.33 cm/sec, p = 0.008) and overweight (6.82 versus 6.46 cm/sec, p = 0.047) groups. There were no differences in 5-min APGAR score < 7, neonatal intensive care unit admission, hypoglycemia and hyperglobulinemia between the groups.

Conclusions:

We observed fetal myocardial dysfunction in overweight and obese pregnant women with higher LV Mod-MPI, LV MPI' and RV E' compared to fetuses from normal weight pregnant women.

Keywords

Myocardial performance indexTissue DopplerObesityOverweightFetal heart functionFetal echocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 2 , February 2024 , pp. 319 - 324
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Blüher, M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol 2019; 15: 288–298.CrossRefGoogle Scholar
Battista, MC, Calvo, E, Chorvatova, A, et al. Intra-uterine growth restriction and the programming of left ventricular remodelling in female rats. J Physiol 2005; 565: 197–205.CrossRefGoogle ScholarPubMed
Xu, Y, Williams, SJ, O’Brien, D, Davidge, ST. Hypoxia or nutrient restriction during pregnancy in rats leads to progressive cardiac remodeling and impairs postischemic recovery in adult male offspring. FASEB J 2006; 20: 1251–1253.CrossRefGoogle ScholarPubMed
Crispi, F, Miranda, J, Gratacós, E. Long-term cardiovascular consequences of fetal growth restriction: biology, clinical implications, and opportunities for prevention of adult disease. Am J Obstet Gynecol 2018; 218: S869–S79.CrossRefGoogle ScholarPubMed
Crispi, F, Crovetto, F, Rodriguez-López, M, et al. Postnatal persistence of cardiac remodeling and dysfunction in late fetal growth restriction. Minerva Obstet Gynecol 2021; 73: 471–481.Google ScholarPubMed
Calvert, JW, Lefer, DJ, Gundewar, S, et al. Developmental programming resulting from maternal obesity in mice: effects on myocardial ischaemia-reperfusion injury. Exp Physiol 2009; 94: 805–814.CrossRefGoogle ScholarPubMed
Barker, DJ, Osmond, C, Golding, J, et al. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ 1989; 298: 564–567.CrossRefGoogle ScholarPubMed
Barker, DJ. Fetal programming of coronary heart disease. Trends Endocrinol Metab 2002; 13: 364–368.CrossRefGoogle ScholarPubMed
Meyer, K, Zhang, L. Fetal programming of cardiac function and disease. Reprod Sci 2007; 14: 209–216.CrossRefGoogle Scholar
Crispi, F, Sepúlveda-Martínez, Á., Crovetto, F, et al. Main patterns of fetal cardiac remodeling. Fetal Diagn Ther 2020; 47: 337–344.CrossRefGoogle ScholarPubMed
Kai, H, Kuwahara, F, Tokuda, K, Imaizumi, T. Diastolic dysfunction in hypertensive hearts: roles of perivascular inflammation and reactive myocardial fibrosis. Hypertens Res 2005; 28: 483–490.CrossRefGoogle ScholarPubMed
Huang, Y, Yan, X, Zhao, JX, et al. Maternal obesity induces fibrosis in fetal myocardium of sheep. Am J Physiol Endocrinol Metab 2010; 299: E968–E75.CrossRefGoogle ScholarPubMed
Wang, J, Ma, H, Tong, C, et al. Overnutrition and maternal obesity in sheep pregnancy alter the JNK-IRS-1 signaling cascades and cardiac function in the fetal heart. FASEB J 2010; 24: 2066–2076.CrossRefGoogle ScholarPubMed
Ece, I, Uner, A, Balli, S, et al. The effects of pre-pregnancy obesity on fetal cardiac functions. Pediatr Cardiol 2014; 35: 838–843.CrossRefGoogle ScholarPubMed
Ingul, CB, Lorås, L, Tegnander, E, et al. Maternal obesity affects fetal myocardial function as early as in the first trimester. Ultrasound Obstet Gynecol 2016; 47: 433–442.CrossRefGoogle Scholar
Donofrio, MT, Moon-Grady, AJ, Hornberger, LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American heart association. Circulation 2014; 129: 2183–2242.CrossRefGoogle ScholarPubMed
Lobmaier, SM, Cruz-Lemini, M, Valenzuela-Alcaraz, B, et al. Influence of equipment and settings on myocardial performance index repeatability and definition of settings to achieve optimal reproducibility. Ultrasound Obstet Gynecol 2014; 43: 632–639.CrossRefGoogle ScholarPubMed
Comas, M, Crispi, F. Assessment of fetal cardiac function using tissue doppler techniques. Fetal Diagn Ther 2012; 32: 30–38.CrossRefGoogle ScholarPubMed
Peixoto, AB, Bravo-Valenzuela, NJ, Rocha, LA, Araujo Júnior, E. Spectral Doppler, tissue Doppler, and speckle-tracking echocardiography for the evaluation of fetal cardiac function: an update. Radiol Bras 2021; 54: 99–106.CrossRefGoogle ScholarPubMed
Hernandez-Andrade, E, Benavides-Serralde, JA, Cruz-Martinez, R, et al. Evaluation of conventional Doppler fetal cardiac function parameters: E/A ratios, outflow tracts, and myocardial performance index. Fetal Diagn Ther 2012; 32: 22–29.CrossRefGoogle ScholarPubMed
Hernandez-Andrade, E, López-Tenorio, J, Figueroa-Diesel, H, et al. A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment. Ultrasound Obstet Gynecol 2005; 26: 227–232.CrossRefGoogle ScholarPubMed
Peixoto, AB, Bravo-Valenzuela, NJM, Martins, WP, et al. Reference ranges for the left ventricle modified myocardial performance index, respective time periods, and atrioventricular peak velocities between 20 and 36 + 6 weeks of gestation. J Matern Fetal Neonatal Med 2021; 34: 456–465.CrossRefGoogle ScholarPubMed
Peixoto, AB, Bravo-Valenzuela, NJ, Martins, WP, et al. Reference ranges for left, right and interventricular septum indices at 20 to 36+6 weeks of gestation derived using spectral myocardial tissue Doppler on Voluson ultrasound machines. Med Ultrason 2019; 21: 279–287.CrossRefGoogle Scholar
Faul, F, Erdfelder, E, Lang, AG, Buchner, A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175–191.CrossRefGoogle ScholarPubMed
Zielinsky, P, Piccoli, AL. Myocardial hypertrophy and dysfunction in maternal diabetes. Early Hum Dev 2012; 88: 273–278.CrossRefGoogle ScholarPubMed
Aguilera, J, Semmler, J, Coronel, C, et al. Paired maternal and fetal cardiac functional measurements in women with gestational diabetes mellitus at 35-36 weeks' gestation. Am J Obstet Gynecol 2020; 223: 574.e1–574.e15.CrossRefGoogle ScholarPubMed
Depla, AL, De Wit, L, Steenhuis, TJ, et al. Effect of maternal diabetes on fetal heart function on echocardiography: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021; 57: 539–550.CrossRefGoogle ScholarPubMed
den Harink, T, Roelofs, MJM, Limpens, J, et al. Maternal obesity in pregnancy and children’s cardiac function and structure: a systematic review and meta-analysis of evidence from human studies. PLoS One 2022; 17: e0275236.CrossRefGoogle ScholarPubMed
Barker, PC, Houle, H, Li, JS, et al. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging. Echocardiography 2009; 26: 28–36.CrossRefGoogle ScholarPubMed
Peng, QH, Zhou, QC, Zeng, S, et al. Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging. Prenat Diagn 2009; 29: 1149–1155.CrossRefGoogle ScholarPubMed
Ali, S, Okasha, A, Elsirgany, S, et al. Normal reference ranges for fetal cardiac function: assessed by modified Doppler myocardial performance index (Mod MPI) in the Egyptian population. Eur J Obstet Gynecol Reprod Biol 2020; 251: 66–72.CrossRefGoogle ScholarPubMed
Lee-Tannock, A, Hay, K, Gooi, A, Kumar, S. Longitudinal assessment of ventricular strain, tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE) in fetuses from pregnancies complicated by diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2021; 256: 364–371.CrossRefGoogle ScholarPubMed
Colan, SD, Parness, IA, Spevak, PJ, Sanders, SP. Developmental modulation of myocardial mechanics: age- and growth-related alterations in afterload and contractility. J Am Coll Cardiol 1992; 19: 619–629.CrossRefGoogle ScholarPubMed
Toemen, L, Gaillard, R, van Osch-Gevers, L, et al. Tracking of structural and functional cardiac measures from infancy into school-age. Eur J Prev Cardiol 2017; 24: 1408–1415.CrossRefGoogle ScholarPubMed