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a Chapter 12 Intrauterine Blood Flow and Postnatal Development 171
gions was comparable between the two groups. Men
from the IUGR group had a lower compliance coefficient
in the AO (corrected for body surface area) than
men from the control group. The time course of vasodilatation
in the IUGR group appeared to be different
from the control group with higher values of flowmediated
vasodilatation at 2 min after cuff deflation
in the IUGR group. Smaller aortic dimensions and
the lower aortic compliance coefficient seen in male
adolescents with previous IUGR may influence the future
cardiovascular health of these individuals. Sustained
flow-mediated vasodilatation may indicate an
increased synthesis of nitric oxide in response to
forearm occlusion.
Retinal Vascular Morphology
at 18 Years of Age [89]
In the cohort of young adults, followed by us, we
found that increasing negative birth-weight deviation
was associated with a decrease in the number of retinal
vascular branching points (p=0.02; Fig. 12.5).
Neither age at examination, gender, nor the degree of
abnormal fetal blood flow were associated with the
number of retinal vessel-branching points. It is unclear
whether the finding of reduced vessel-branching
points in IUGR subjects is restricted to the retina or
whether it reflects a more general affection of vascular
growth within the body. A previous study in
IUGR rats induced by protein restriction has shown
reduced vasculature in the cerebral cortex [90]. Our
findings of a reduced size of large arteries in subjects
with IUGR detected at 9 and 19 years of age, and that
of a reduced number of branches in the retinal vasculature,
support a general affection of angiogenesis.
Others have shown signs of impaired endothelial
function in small and large arteries in school children
born SGA [91]. We found that aortic compliance appeared
unaffected at 9 years of age [80], whereas men
at 19 years of age had signs of decreased compliance
[88]. These findings of functional and morphological
deficits may contribute to a better understanding of
the link between restricted fetal growth and cardiovascular
disease.
Conclusion
In conclusion, several studies have shown abnormal
fetal hemodynamics in the growth-restricted fetus,
especially umbilical AREDF, to be associated with a
clear increase in perinatal mortality and neonatal
morbidity. The long-term follow-up studies performed
until now did not show clear evidence of major
neurological handicap being associated with abnormal
fetal hemodynamics. This is not surprising as
Fig. 12.5. a Ocular fundus photography demonstrating a
reduced number of retinal vessel-branching points in an
18-year-old female with an SGA birth weight and abnormal
fetal aortic blood flow (BFC III). b Ocular fundus photography
with a normal number of retinal vessel-branching
points in an 18-year old female with normal fetal growth
and normal fetal aortic blood flow. (From Hellstræm et al.
[89])
the much larger body of prospective follow-up studies
on IUGR, in terms of birth-weight SGA, seldom
showed an increase in major neurological impairment
associated with fetal growth impairment. Minor neurological
dysfunction, behavioral abnormality, and
learning problems at school age, all frequently reported
as overrepresented in perinatal risk groups,
would probably be more adequate as outcome vari-