Peer-reviewed article
Antenatal Markers Related to Fetal Growth Restriction Can Predict Childhood Systolic Blood Pressure
Perchard R, Garner T, Whatmore A, Stevens A, Higgins L et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether markers of fetal growth restriction measured before birth can predict high blood pressure in young children. Researchers measured blood pressure in 75 children aged 3-6 years born to mothers identified as having higher fetal growth restriction risk, and compared this with ultrasound and blood test data collected during pregnancy. The study found that combining information about the mother's blood pressure, the baby's birth weight, and ultrasound findings could accurately identify which children would have higher systolic blood pressure in early childhood.
Key points
- Antenatal markers of fetal growth restriction predicted upper quartile childhood systolic blood pressure with 97% accuracy (AUC 0.97)
- The five most important predictive factors were maternal diastolic blood pressure, birthweight standard deviation score, parity, uterine artery Doppler notching, and change in estimated fetal weight between 23 weeks and birth
- Study included 75 children aged 3-6 years from the Manchester BabyGRO Study, born to mothers with identified higher fetal growth restriction risk
- Machine learning analysis (random forest) was used to determine relative importance of multiple antenatal variables
Limitations
The study is small (n=75) and limited to children of mothers identified as having higher fetal growth restriction risk, so findings may not generalise to the broader population. The cross-sectional measurement of childhood blood pressure cannot determine causation or long-term cardiovascular outcomes.
Abstract
Abstract Background: Being born small for gestational age (SGA) is linked with higher systolic blood pressure (SBP). Fetuses with growth restriction (FGR) may be either SGA or appropriate size for gestational age at birth. However, it is not known which factors contributing to size at birth influence the relationship with SBP. Aim. To determine whether antenatal markers of FGR can predict the upper quartile of childhood SBP. Methods: Brachial SBP was measured for 75 children aged 3-6 years from the Manchester BabyGRO Study, using a Tensiomed®Arteriograph with a child-sized cuff. SBP quartiles were generated. Participants were born to mothers who had attended a specialised clinic, following identification of higher FGR risk based on abnormal maternal serology (pregnancy associated plasma protein-A, β-human chorionic gonadotrophin, α-fetoprotein, Inhibin-A). Antenatal ultrasound data at 23 weeks gestation were obtained. Uterine artery Doppler (UtAD) notching was assigned a rank (0=absent, 1=unilateral, 2=bilateral). Random forest (RF) is a machine learning approach that generates many independent, uncorrelated decision trees based on multiple variables. This was used to determine the relative importance of antenatal variables in prediction of upper quartile of childhood SBP. Variables included in the model were maternal body mass index (BMI), parity, ethnicity (black/white/asian/mixed), maternal SBP and diastolic BP (DBP), maternal serology relating to FGR risk, UtAD pulsatility index, resistance index and notching rank (all measures of uteroplacental blood flow resistance), placental size measurements, 23 week estimated fetal weight (EFW) centile, ∆23w EFW-birthweight centile and birthweight SDS. A receiver operating characteristic (ROC) curve was generated, providing an area under the curve (AUC). A variable of importance (VIP) score was calculated for each marker that was significant in the model. All analyses were conducted in R (version 3.6). Results: RF analysis demonstrated antenatal markers relating to FGR risk predict the upper quartile of childhood SBP with an AUC 0.97. The top five ranked variables were maternal DBP (VIP score 14.0), birthweight SDS (11.5), parity (9.9), notching rank (9.5) and ∆23w EFW-birthweight centile (9.1). Conclusion: Maternal and antenatal markers, as well as birthweight SDS are linked with the upper quartile of SBP at 3-6 years. Antenatal markers were within the top five ranked and could help identify those babies at risk of higher SBP in childhood.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Use of antenatal ultrasound markers (uterine artery Doppler, placental size, fetal weight), maternal blood tests (serology for fetal growth restriction risk), and maternal characteristics (blood pressure, BMI, parity) combined with machine learning to predict upper quartile childhood systolic blood
- Population
- 75 children aged 3-6 years born to mothers identified as having higher fetal growth restriction risk based on abnormal maternal serology
Key finding
Antenatal markers predicted upper quartile childhood systolic blood pressure with AUC of 0.97