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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Neil Patel, Royal Hospital for Children, UK
- Second opponent: Senior Consultant Anlaug Vatne, Stavanger University Hospital,
- Third member and chair of the evaluation committee: Professor II Rune Svenningsen, University of Oslo
Chair of the Defence
Professor II Anne Flem Jacobsen, University of Oslo
Principal Supervisor
Associate Professor Eirik Nestaas, University of Oslo
Summary
Fetal growth restriction (FGR) due to placental insufficiency may lead to cardiac and circulatory adaptations in the fetus that can persist after birth and increase perinatal morbidity and mortality.
The aims of the thesis were to study the consequences of these adaptations the first postnatal days by use of a contemporary FGR definition, and if adjusting for gestational age (GA, weeks), birth weight (BW), sex and twin/singleton influenced the results.
We conducted a prospective, observational cohort study at Oslo University Hospital from April 2017 to October 2018 to assess cardiac morphology, function and circulation. Seven Early-FGR (GA 30+0 - 31+6), 23 Late-FGR (GA 32+0 - 42+0), and 39 healthy controls (GA 34+0 - 42+0) with prenatally verified normal growth and circulation were examined by echocardiography on day one, two, and three after birth.
We compared Late-FGR with controls and Early-FGR with Late-FGR. Results differed between unadjusted and adjusted analyses. Late-FGR neonates had modest signs of cardiac remodelling when adjusting for GA, BW, sex and twin/singleton. The most prominent findings in the study were that compared with controls, Late-FGR exhibited a slimmer and more elongated right ventricle, had stronger septal contraction, and higher peak diastolic septal and right wall tissue Doppler velocity during atrial contraction (a’ velocities). The impact on blood flow was limited. The transitional changes happened early in the study period, and FGR had no impact on these changes. Unexpectedly, Late-FGR did not show a globular shape or hypertrophy in the left ventricle or signs of diastolic dysfunction. Early-FGR had similar findings as Late-FGR in adjusted analyses, but the small sample size of Early-FGR limited analyses only to demonstrate large differences between the groups.
We found that FGR had less impact on cardiac and circulatory adaptations than previously reported, possibly due to a mild phenotype in the majority of the Late-FGR group.