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Klin Padiatr 2017; 229(04): 209-215
DOI: 10.1055/s-0043-104528
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Intrauterine Growth Restriction (IUGR) Induces Signs of Subclinical Atherosclerosis in 6-Year-Old Infants Despite Absence Of Excessive Growth

Intrauterine Wachstumsrestriktion (IUGR) induziert eine subklinische Arteriosklerose bei 6-jährigen Kindern ohne übermäßiges Aufholwachstum
Anja Tzschoppe
1   Department of Paediatrics and Adolescent Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
,
Rüdiger von Kries
2   Institute of Social Paediatrics and Adolescent Medicine, University of Munich, München Germany
,
Ellen Struwe
3   Regional Centre for Social Paediatrics, Klinikum Konstanz, Konstanz, Germany
,
Wolfgang Rascher
1   Department of Paediatrics and Adolescent Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
,
Helmuth-Guenther Dörr
1   Department of Paediatrics and Adolescent Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
,
Jörg Jüngert
1   Department of Paediatrics and Adolescent Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
,
Manfred Rauh
1   Department of Paediatrics and Adolescent Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
,
Matthias Beckmann
4   Department of Obstetrics and Gynaecology, University of Erlangen-Nuremberg, Erlangen , Germany
,
Ralf Schild
5   Department of Obstetrics and Gynaecology, DIAKOVERE gGmbH, Hannover, Germany
,
Tamme W. Goecke
6   Department of Obstetrics and Gynaecology, University of Aachen, Aachen, Germany
,
Jörg Dötsch
7   Department of Paediatrics and Adolescent Medicine University of Cologne, Köln, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
17 July 2017 (online)

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Abstract

Background Postnatal catch-up growth and rapid weight gain after intrauterine growth restriction (IUGR) seem to increase the risk for later disease. This study aimed to compare features of the metabolic syndrome early in life between IUGR and appropriate for gestational age (AGA) infants.

Patients Data for 9 infants with IUGR defined by a birth weight<10th percentile and ultrasound-proven placental insufficiency and 11 AGA children were available.

Method Postnatal growth, auxological, cardiovascular, and metabolic parameters up to a chronological age of 6 years were assessed: Fasting serum concentrations of LDL-cholesterol, insulin, leptin, IGF-I, DHEAS, skinfold thicknesses, blood pressure, and mean carotid intima-media thickness (cIMT).

Results All IUGR infants showed catch-up growth, although mean BMI SDS and total subcutaneous fat mass at the age of 6 years were still slightly lower compared to the AGA cohort. Reduced serum leptin concentrations were observed in IUGR infants (p=0.02), whereas no significant difference was found for IGF-I, insulin, LDL-cholesterol and DHEAS concentrations. Mean cIMT was significantly higher in IUGR infants (p<0.05). Mean arterial pressure did no differ.

Discussion and Conclusion In 6-year-old IUGR infants with catch-up growth, who still had a slightly reduced BMI SDS compared to the AGA group, signs of subclinical atherosclerosis were detectable suggesting that cardiovascular risk in IUGR may be present even in the absence of excessive growth.

Zusammenfassung

Hintergrund Postnatales Aufholwachstum und rasche Gewichtszunahme nach intrauteriner Wachstumsrestriktion (intrauterine growth restriction, IUGR) scheinen das Risiko für spätere Folgeerkrankungen zu erhöhen. Ziel dieser Studie war es, das Auftreten von Symptomen des metabolischen Syndroms in früher Kindheit zwischen IUGR-Kindern und Kindern mit normalem Geburtsgewicht (appropriate for gestational age, AGA) zu vergleichen.

Patienten Daten von 9 Kindern nach IUGR, definiert durch ein Geburtsgewicht<10. Perzentile und eine sonografisch nachgewiesene Plazentainsuffizienz, und 11 AGA-Kindern waren verfügbar.

Methode Postnatales Wachstum sowie folgende auxologische, kardiovaskuläre und metabolische Parameter bis zu einem chronologischen Alter von 6 Jahren wurden analysiert: Nüchtern-Serumkonzentrationen von LDL-Cholesterin, Insulin, Leptin, IGF-I, DHEAS, Hautfaltendickemessungen, Blutdruck und Intima-Media-Dicke der A. carotis communis beidseits (carotid intima-media thickness, cIMT).

Ergebnisse Alle IUGR-Kinder zeigten Aufholwachstum, wobei der mittlere BMI SDS und die subkutane Fettgewebsmasse im Alter von 6 Jahren noch leicht reduziert im Vergleich zur AGA-Kohorte waren. Die Konzentration von Leptin im Serum war erniedrigt bei den IUGR Kindern (p=0.02), kein signifikanter Unterschied fand sich für IGF-I, Insulin, LDL-Cholesterin und DHEAS. Die durchschnittliche cIMT war signifikant höher bei den IUGR-Kindern (p<0,05). Der mittlere arterielle Blutdruck unterschied sich nicht.

Diskussion und Schlussfolgerung Bei 6-jährigen IUGR-Kindern mit Aufholwachstum, deren BMI SDS weiterhin leicht erniedrigt im Vergleich zur AGA-Gruppe war, fanden sich subklinische arteriosklerotische Veränderungen, was auf ein erhöhtes kardiovaskuläres Risiko bei IUGR trotz fehlenden übermäßigen Aufholwachstums hinweisen könnte.

Key words

intrauterine growth restriction - foetal programming - catch-up growth - subclinical atherosclerosis - FIPS study

Schlüsselwörter

Intrauterine Wachstumsrestriktion - fetale Programmierung - Aufholwachstum - subklinische Arteriosklerose - FIPS-Studie
 

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