Fetal cardiac remodeling in preeclampsia and fetal growth restriction: a long-term cardiovascular risk

Reprogramación cardiaca fetal en preeclampsia y restricción de crecimiento fetal: un riesgo cardiovascular a largo plazo

Introduction: the fetal period is characterized by rapid cell proliferation and differentiation that can lead to changes in normal organ function. Heart structural and functional modifications occur in restricted fetuses, and may persist until childhood and adolescence, and predispose to cardiovascular diseases. Objective: to conduct a literature search to determine the relationship between cardiac remodeling in restricted fetuses and offsprings of preeclamptic mothers, and its association with cardiovascular risk. Methodology: a search performed from December 2020 to June 2021 in PubMed, Scielo, Lilacs, Ovid, Embase, ScienceDirect and Medline databases using Mesh validation keywords. Results: 36 articles were selected, finding there are fetal cardiac structural and functional changes in restricted fetuses, as those occurring in offsprings of preeclamptic mothers. Elongated and globular hearts are seen in the initial phase, featuring higher sphericity indices that may progress to hypertrophy, and signs of both systolic and diastolic cardiac dysfunction, corroborated by elevated umbilical cord blood troponin and natriuretic peptide levels, as compared with healthy fetuses. Cardiac changes persist until childhood, adolescence and adulthood. Conclusion: preeclampsia and fetal growth restriction induce cardiac remodeling in utero, leading to cardiovascular risk factors. Initiating preventive actions is crucial to prevent extrauterine life factors (“second hit”) from increasing the risk of developing cardiovascular disease or death.