Cardiac Displacement From Third Trimester to Early Childhood

Study Overview
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Brief Summary
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The aim is to increase awareness of the relationship between (IUGR) and cardiac function in the foetus, the development of cardiac function over time after delivery and what significance a possible early disturbed myocardial function have for the neonate and the child during the first years of life.

Detailed Description
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This is a prospective case-control study in which fetuses from normal pregnancies will be compared with fetuses with IUGR. Parents will be asked to participate in the study in connection with the routine ultrasound examinations at the department of obstetrics to where they have been referred because of suspected IUGR. The control group will be randomly selected among pregnant women who come for routine ultrasound during pregnancy at gestational week 18-20. Surveys will be performed in the third trimester and after delivery. During the ultrasound examinations standardized, moving sequences of the heart will be saved. Analyses will be performed off-line and analysed by vector velocity imaging software. With this technique, the investigator can quantify the chamber wall and myocardial movements. Speed (velocity), movement (displacement) and thickening/deformation (strain and strain rate) will be recorded in a structured and standardized manner. When performing the analysis the heart's walls are outlined and the software extracts the movement in different directions. Data will be obtained concerning the participating mothers previous illness, mothers' age, maternal smoking, BMI, any abnormalities during pregnancy, number of previous pregnancies. Other data that will be recorded are means of delivery and any abnormalities during previous pregnancies, such as hypertension, preeclampsia and pre-natal steroid treatment. Additional data to be collected from the participating fetuses are flow profiles in the umbilical artery, ductus venosus and middle cerebral artery. Abdominal circumference and estimated weight will be registered. Following delivery, the participating child's height, weight, head circumference and gestational age at birth are registered. Additional data that will be collected after delivery are umbilical vein and umbilical artery acid base values, Apgar score. If admitted to the pediatric ward the investigators will register the number of days hospitalized in the ward for post-natal care and diagnosis. The investigators plan to examine the participating baby with cardiac ultrasound between 12 and 72 hours after delivery and again when the participating child is 3-4 months old and at 7 years of age. The investigators will take a blood sample from the umbilical cord at birth and again at 7 years of age. The investigators will analyse the blood for growth factors and cardiac markers. An additional ethical approval was accepted 2015 for analysing epigenetic factors in the participating children's DNA. Based on power calculation the investigators plan to examine between 20-30 fetuses with IUGR and 40-60 healthy fetuses in the control group.

Official Title
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Cardiac Displacement From Third Trimester to Early Childhood

Conditions
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IUGR, Fetal Growth Retardation, Intrauterine Growth Restriction

Intervention / Treatment
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* Other: Echocardiography
* Procedure: Blood sample


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inclusion of research subjects: Growth restriction in routine pregnancy ultrasound, verified by specialist control. Gestational age based on Crown Rump Length measurements during the first trimester. Growth restriction defined by a deviation more than 22% from the normal curve at a given gestational age or growth rate deviates more than 10% compared to the previous measurement in relation to the expected weight. Inclusion of controls: Control individuals recruited among mothers who come to routine pregnancy ultrasound control at gestational week 18. These are randomly selected and then asked to participate. Exclusion Criteria: Exclusion of both the cases with IUGR and the control cases are major malformations, twin pregnancy, signs of intrauterine infection during pregnancy, significant illness or significant medical treatment of the mother.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Fetuses/Children with IUGR<br>The moving sequences of the heart movement are collected at the regular ultrasound examinations during pregnancy. Following delivery the investigators plan to examine the baby with cardiac ultrasound, echocardiography, between 12 and 72 hours after delivery and again when the child is 3-4 months old and at 7 years of age. Blood sample will be taken from the umbilical cord at birth and again at 7 years of age. The investigators will analyse the blood for growth factors and cardiac markers. An additional ethical approval was accepted 2015 for analysing epigenetic factors in the children's DNA. | Other: Echocardiography<br>* During the ultrasound examinations standardized, moving sequences of the heart will be saved. Analyzes are performed off-line and analyzed by vector velocity imaging software.<br>Procedure: Blood sample<br>* The investigators will take a blood sample from the umbilical cord at birth and again at 7 years of age.<br>|
| Healthy Controls<br>The moving sequences of the heart movement are collected at two occasions approximately 4 weeks apart. This takes place during gestational weeks 28-36. Following delivery the investigators plan to examine the baby with cardiac ultrasound, echocardiography, between 12 and 72 hours after delivery and again when the child is 3-4 months old and at 7 years of age. Blood sample will be taken from the umbilical cord at birth and again at 7 years of age. The investigators will analyze the blood for growth factors and cardiac markers. An additional ethical approval was accepted 2015 for analysing epigenetic factors in the children's DNA. | Other: Echocardiography<br>* During the ultrasound examinations standardized, moving sequences of the heart will be saved. Analyzes are performed off-line and analyzed by vector velocity imaging software.<br>Procedure: Blood sample<br>* The investigators will take a blood sample from the umbilical cord at birth and again at 7 years of age.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Velocity of the cardiac walls | Echocardiography images of the heart's walls are outlined and the software extracts the movement in different directions. | At least two times before delivery from gestational age 28 weeks to delivery. Three times after delivery, 12-72 hours, 3-4 months and 7 years. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Displacement of the cardiac walls | Echocardiography images of the heart's walls are outlined and the software extracts the movement in different directions. | At least two times before delivery from gestational age 28 weeks to delivery. Three times after delivery, 12-72 hours, 3-4 months and 7 years. | 
| Strain in the cardiac walls | Echocardiography images of the heart's walls are outlined and the software extracts the movement in different directions. | At least two times before delivery from gestational age 28 weeks to delivery. Three times after delivery, 12-72 hours, 3-4 months and 7 years. | 
| Cardiac marker Troponin T | Comparing cardiac marker troponin T between the two groups | At birth and at 7 years of age | 
| Cardiac marker N-terminal prohormone of brain natriuretic peptide (NT-ProBNP) | Comparing cardiac marker NT-ProBNP between the two groups | At birth and at 7 years of age | 
| Insulin-like growth factor-1 (IGF-1) | Comparing IGF-1 between the two groups | At birth and at 7 years of age | 
| Insulin-like growth factor binding protein (IGFBP) | Comparing IGFBP between the two groups | At birth and at 7 years of age | 
| DNA methylation and gene expression in blood monocytes and lumfocytes | Changes in DNA metylation will be compared between the two groups | At birth and at 7 years of age | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pro-brain natriuretic peptide (1-76), Insulin-Like Growth Factor Binding Proteins, Insulin-Like Growth Factor I, Echocardiography, Velocity Vector Imaging, Heart Function Tests