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Remodeling of the Cardiovascular Circulation in Fetuses of Mothers With Diabetes: a Fetal Computational Model Analysis

Kulkarni, A; Garcia-Canadilla, P; Khan, A; Lorenzo, JM; Beckerman, K; Valenzuela-Alcaraz, B; Cruz-Lemini, M; ... Bijnens, B; + view all (2018) Remodeling of the Cardiovascular Circulation in Fetuses of Mothers With Diabetes: a Fetal Computational Model Analysis. Placenta , 63 pp. 1-6. 10.1016/j.placenta.2017.12.020. Green open access

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Abstract

AIMS: Myocardial structural and functional abnormalities are known to occur in fetuses of mothers with diabetes mellitus (FMDM). The main aim of this investigation was to explore the cardiovascular circulatory patterns in FMDM using a validated lumped computational model of the cardiovascular system. METHODS: This was a multi-institutional study involving FMDM compared to fetuses of maternal controls (FC). Fetal echocardiographic Doppler data from left and right ventricular outflow tracts, aortic isthmus, middle cerebral and umbilical arteries were fitted into a validated fetal circulation computational model to estimate patient-specific placental and vascular properties. Non-parametric comparisons were made between resistances, compliances and flows in the brain and placenta in FMDM and FC. RESULTS: Data from 23 FMDM and 31 FC were fitted into the model. In FMDM, compared to FC, placental relative resistance was lower (0.59 ± 0.50 versus 0.91 ± 0.41; p < .05) with higher brain relative resistance (2.36 ± 1.65 versus 1.60 ± 0.85; p < .05). Middle cerebral artery flow was lower in FMDM than FC (0.12 ± 0.14 vs. 0.27 ± 0.21 ml/min; p 0.04) with a lower cerebral-placental flow ratio. Combined stroke volume was lower in FMDM (3.65 ± 2.05 ml) than FC (4.97 ± 2.45 ml) (p 0.04). CONCLUSIONS: Blood flow is redistributed in FMDM to the placenta, away from the brain. This alteration may play a role in the postnatal health of these fetuses.

Type: Article
Title: Remodeling of the Cardiovascular Circulation in Fetuses of Mothers With Diabetes: a Fetal Computational Model Analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.placenta.2017.12.020
Publisher version: https://doi.org/10.1016/j.placenta.2017.12.020
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Fetus, Mothers with diabetes mellitus, Computational model, Resistance, Compliance
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
URI: https://discovery.ucl.ac.uk/id/eprint/10058532
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