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Postnatal Prognosis

  • Erich Cosmi
  • Matteo Andolfatto
  • Matteo Arata
  • Marilia Calanducci
  • Silvia Visentin
Chapter

Abstract

People with fetal growth restriction (FGR) and a low birth weight possess a more limited nephron mass (in proportion to their body size), a reduced renal volume, and a smaller quantity of glomeruli. From a physiopathological standpoint, FGR due to placental insufficiency is a mainly vascular disorder caused by the chronic vasoconstriction suffered by tertiary villi owing to inadequate trophoblastic invasion of the maternal spiral arteries. The resulting hypoxia affects sodium and potassium channels, and the consequent adaptive response leads to the onset of a chronic vasoconstriction. In the initial stages of this pathological condition, the fetus reacts by reducing its growth rate and increasing its oxygen extraction capacity. In the long term, however, hypoxemia sets in and may persist for weeks, with a subsequent activation of specific chemoreceptors and cardiovascular modifications designed to preserve the delivery of oxygen to the major organs, for example the heart, brain and adrenal glands. Recent ultrasound studies have revealed significant differences in fetuses with FGR based on comparisons with normal fetuses, especially as concerns diastolic function. This cardiac dysfunction would seem to be a constitutive characteristic of growth restriction, which would begin early, remain in a subclinical stage (demonstrated by a normal cardiac output), and then gradually deteriorate. For the time being, however, the exact pathophysiology of hypoxic damage in fetuses with FGR and its influence on the development of the cardiocirculatory system in adults remain the topic of lively scientific debate.

Keywords

Fetal growth restriction Cardiovascular risk Endothelial damage Doppler Kidney Programming 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Erich Cosmi
    • 1
    • 2
  • Matteo Andolfatto
    • 2
  • Matteo Arata
    • 2
  • Marilia Calanducci
    • 2
  • Silvia Visentin
    • 2
  1. 1.University of Padua School of MedicineDeparment of Woman and Child HealthPaduaItaly
  2. 2.Department of Woman and Child HealthMaternal Fetal Medicine Unit, University of PaduaPaduaItaly

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