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Fetal programming as a predictor of adult health or disease: the need to reevaluate fetal heart function

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Abstract

Epidemiologic and experimental evidence suggests that adverse stimuli during critical periods in utero permanently alters organ structure and function and may have persistent consequences for the long-term health of the offspring. Fetal hypoxia, maternal malnutrition, or ventricular overloading are among the major adverse conditions that can compromise cardiovascular development in early life. With the heart as a central organ in fetal adaptive mechanisms, a deeper understanding of the fetal cardiovascular physiology and of the echocardiographic tools to assess both normal and stressed pregnancies would give precious information on fetal well-being and hopefully may help in early identification of special risk groups for cardiovascular diseases later in life. Assessment of cardiac function in the fetus represents an additional challenge when comparing to children and adults, requiring advanced training and a critical approach to properly acquire and interpret functional parameters. This review summarizes the basic fetal cardiovascular physiology and the main differences from the mature postnatal circulation, provides an overview of the particularities of echocardiographic evaluation in the fetus, and finally proposes an integrated view of in utero programming of cardiovascular diseases later in life, highlighting priorities for future clinical research.

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Abbreviations

AV:

Atrioventricular

ECG:

Electrocardiogram

FGR:

Fetal growth restriction

LV:

Left ventricle

MPI:

Myocardial performance index

RV:

Right ventricle

TDI:

Tissue Doppler imaging

TTTS:

Twin-to-twin transfusion syndrome

2D-ST:

2D-speckle tracking

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Authors and Affiliations

  1. Department of Pediatric Cardiology, São João Hospital, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    Joana O. Miranda & José Carlos Areias

  2. Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal

    Joana O. Miranda

  3. Center of Prenatal Diagnosis, Department of Gynecology and Obstetrics, São João Hospital, Porto, Portugal

    Carla Ramalho

  4. Faculty of Medicine, University of Porto, Porto, Portugal

    Carla Ramalho

  5. Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal

    Carla Ramalho

  6. Cardiovascular R&D Centre (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal

    Tiago Henriques-Coelho

  7. Department of Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal

    Tiago Henriques-Coelho & José Carlos Areias

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  1. Joana O. Miranda
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Miranda, J.O., Ramalho, C., Henriques-Coelho, T. et al. Fetal programming as a predictor of adult health or disease: the need to reevaluate fetal heart function. Heart Fail Rev 22, 861–877 (2017). https://doi.org/10.1007/s10741-017-9638-z

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