Assessment of fetal cardiac morphology and functional changes in early-onset and late-onset fetal growth restriction.

OBJECTIVE
To compare the fetal cardiac morphology and functions of the early-onset fetal growth restriction (EO-FGR) and late-onset fetal growth restriction (LO-FGR) groups with gestational weeks-matched controls.


METHODS
A total of 164 pregnant women were included, 28 of whom were in the EO FGR, 54 in the LO FGR, and 82 in the control group. Fetal echocardiographic evaluation was performed with two-dimensional (2D), M-mode, and tissue Doppler imaging (TDI) and pulsed wave (PW) Doppler.


RESULTS
Fetal cardiac morphological measurements and diastolic and systolic functions changed in EO and LO FGR fetuses compared to controls. The EO-and LO-FGR fetuses had reduced right and left cardiac output, increased myocardial performance index , and significantly higher mitral and tricuspid E/ E' ratios than controls . The EO-FGR fetuses had lower mitral and tricuspid E and E' values. In LO-FGR fetuses, mitral and tricuspid E' values were lower than in their controls (p=.001 and p<.001). On the other hand, the mitral and tricuspid E values were not significantly changed (p=.107 and p=.196).


CONCLUSION
We hypothesized that EO-FGR and LO-FGR fetuses had insufficient myocardial maturation. Especially in the LO FGR fetuses, TDI is the earliest and most sensitive technique to show subtle changes in fetal cardiac functions.