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Physiological adaptation of the growth-restricted fetus

Maršál, Karel LU (2018) In Best Practice and Research: Clinical Obstetrics and Gynaecology 49. p.37-52
Abstract

The growth-restricted fetus in utero is exposed to a hostile environment and suffers undernutrition and hypoxia. To cope with the stress, the fetus changes its physiological functions. These adaptive changes aid intrauterine survival; however, they can lead to permanent functional and structural changes that can contribute to the development of serious chronic diseases later in life. Epigenetic mechanisms are an important part of the pathophysiological processes behind this “developmental origin of adult diseases.” The dominant cardiovascular adaptive change is the redistribution of blood flow in hypoxic fetuses, with preferential supply of blood to the fetal brain, myocardium, and adrenal glands. The proportion of blood from the... (More)

The growth-restricted fetus in utero is exposed to a hostile environment and suffers undernutrition and hypoxia. To cope with the stress, the fetus changes its physiological functions. These adaptive changes aid intrauterine survival; however, they can lead to permanent functional and structural changes that can contribute to the development of serious chronic diseases later in life. Epigenetic mechanisms are an important part of the pathophysiological processes behind this “developmental origin of adult diseases.” The dominant cardiovascular adaptive change is the redistribution of blood flow in hypoxic fetuses, with preferential supply of blood to the fetal brain, myocardium, and adrenal glands. The proportion of blood from the umbilical vein to the ductus venosus and foramen ovale increases, which increases the cardiac output of the left heart ventricle. The increased perfusion of fetal brain can be followed with Doppler ultrasound as increased diastolic velocities and decreased pulsatility index in the middle cerebral artery.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood flow redistribution, Doppler ultrasound, Fetal cardiovascular system, Fetal growth, Fetal physiology, Fetal programming
in
Best Practice and Research: Clinical Obstetrics and Gynaecology
volume
49
pages
16 pages
publisher
Elsevier
external identifiers
  • scopus:85046632380
ISSN
1521-6934
DOI
10.1016/j.bpobgyn.2018.02.006
language
English
LU publication?
yes
id
e55a8bec-7731-4858-a33d-7331b0121199
date added to LUP
2018-05-25 13:14:02
date last changed
2019-07-16 03:50:42
@article{e55a8bec-7731-4858-a33d-7331b0121199,
  abstract     = {<p>The growth-restricted fetus in utero is exposed to a hostile environment and suffers undernutrition and hypoxia. To cope with the stress, the fetus changes its physiological functions. These adaptive changes aid intrauterine survival; however, they can lead to permanent functional and structural changes that can contribute to the development of serious chronic diseases later in life. Epigenetic mechanisms are an important part of the pathophysiological processes behind this “developmental origin of adult diseases.” The dominant cardiovascular adaptive change is the redistribution of blood flow in hypoxic fetuses, with preferential supply of blood to the fetal brain, myocardium, and adrenal glands. The proportion of blood from the umbilical vein to the ductus venosus and foramen ovale increases, which increases the cardiac output of the left heart ventricle. The increased perfusion of fetal brain can be followed with Doppler ultrasound as increased diastolic velocities and decreased pulsatility index in the middle cerebral artery.</p>},
  author       = {Maršál, Karel},
  issn         = {1521-6934},
  keyword      = {Blood flow redistribution,Doppler ultrasound,Fetal cardiovascular system,Fetal growth,Fetal physiology,Fetal programming},
  language     = {eng},
  month        = {05},
  pages        = {37--52},
  publisher    = {Elsevier},
  series       = {Best Practice and Research: Clinical Obstetrics and Gynaecology},
  title        = {Physiological adaptation of the growth-restricted fetus},
  url          = {http://dx.doi.org/10.1016/j.bpobgyn.2018.02.006},
  volume       = {49},
  year         = {2018},
}