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Poor first trimester fetal growth associated with adverse CV risk profile in childhood
Deficiencies in first trimester fetal growth have been linked to increased CV risk in school-aged children, according to recent study results.
Researchers followed 1,184 pregnant women and their children. All were participants in Generation R, a population-based, prospective cohort study conducted in Rotterdam, the Netherlands.
Researchers gathered measurements such as first trimester fetal crown-to-rump length in the gestational age range of 10 to 13 weeks; second and third trimester head circumference; abdominal circumference; and femur length. After birth, growth characteristics were measured at regular intervals by staff at community health centers. All children returned for assessments of potential CVD markers at age 6 years, when researchers measured total fat mass; android and gynoid fat mass; android/gynoid fat mass ratio; BP; total, LDL and HDL cholesterol; triglycerides; insulin; and C-peptide levels.
According to the results, children classified in the lowest fifth of first trimester fetal crown-to-rump length had higher total fat mass percentage, android/gynoid fat mass ratio, diastolic BP and total cholesterol vs. children in the highest fifth of length (P<.05 for all). After adjustment for confounders, each one standard deviation (SD) score greater first trimester crown-to-rump length was associated with lower total fat mass (–0.3%; 95% CI, –0.57 to –0.03), android fat mass (–0.07%; 95% CI, –0.12 to –0.02), android/gynoid fat mass ratio (–0.53; 95% CI, –0.89 to –0.17), diastolic BP (–0.43 mm Hg; 95% CI, –0.84 to –0.01), total cholesterol (–0.05 mmol/L; 95% CI, –0.10 to 0) and LDL cholesterol (–0.04 mmol/L; 95% CI, –0.09 to 0) during childhood.
“Childhood body mass index fully explained the associations of first-trimester fetal crown-to-rump length with childhood total fat mass,” the researchers wrote.
Additionally, each one SD score also was associated with lower risk for clustering of CV risk factors (RR=0.81; 95% CI, 0.66-1) later in life. Clustering of CV risk factors was defined as three or more of the following: high android fat mass, high systolic or diastolic BP, low HDL cholesterol or high triglycerides, and elevated insulin levels.
The researchers also conducted longitudinal growth analyses, which showed that children with clustering of CV risk factors had a small first trimester fetal crown-to-rump length and lower second and third trimester estimated fetal weight but higher weight growth from age 6 months and older vs. children who had no clustering of CV risk factors.
The researchers observed no association between first trimester fetal growth and other CV outcomes.
“These results suggest that the first trimester of pregnancy may be a critical period for development of cardiovascular risk factors in later life,” the researchers concluded. “Future strategies to improve cardiovascular health may start from early pregnancy onwards, or even before conception.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.