Measurement of and relationship between placental size and fetal cardiac development

Abstract

Introduction -Fetal programming is the concept by which a fetus adapts to the intrauterine environment by altering blood flow to various organs which may induce permanent structural and/or functional change in those organs, altering disease susceptibility in later life. We hypothesised that the heart is a susceptible organ and that alterations in blood flow from the placenta in relation to maternal factors may have different effects on each side of the heart. We therefore aimed to assess the feasibility of measuring placental volume and growth, cardiac structure and cardiac function and assess the relationships between these measurements and also to maternal characteristics.

Methods - We undertook a prospective, cross-sectional cohort study of low-risk women. 144 scans were performed on 127 women, 89 in the first trimester (10+6-13+6 weeks gestation) and 55 in the second trimester (18+0-20+6 weeks gestation). 17 of these women were scanned in both trimesters. Measurements performed were the left and right myocardial performance index to assess cardiac function and 3D placental volume. Second trimester cardiac structure was assessed by 2D measurements of total cardiac circumference, total ventricular circumference and internal left and right ventricular circumferences. These measurements were then correlated with each other, standard fetal biometry, maternal body composition, and birth and placental weights.

Results - We developed reliable and reproducible techniques for measuring placental volume in the first and second trimester and relative cardiac chamber sizes in the second trimester, but had difficulty reliably measuring cardiac function by means of the myocardial performance index. We did not find any significant relationships between maternal body composition and fetal cardiac function or structure within our small cohort.

Conclusions - Assessment of fetal cardiac function and structure in relation to maternal nutritional status and stress has the potential for detecting fetuses adapting to an adverse intra-uterine environment. This could assist identification of the maternal factors which lead to increased risk of disease in adult life and facilitate the development of targeted diet and lifestyle interventions.

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ORCID for Keith Godfrey: orcid.org/0000-0002-4643-0618

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