Cardiac Function in Fetal Growth Restriction: A Systematic Review and Meta‐Analysis

Objectives: To compare cardiac function in fetuses with and without fetal growth restriction (FGR). Methods: Medline and Embase databases were searched. Inclusion criteria were pregnancies complicated compared to those non-complicated by FGR, defined according to the Delphi criteria. The following cardiovascular parameters were assessed. Markers of cardiac geometry and morphology, including the left and right sphericity index (SI). Markers primarily affecting the systolic function, including right (TAPSE) and left (MAPSE) cardiac output (CO), atrioventricular plane displacement, and peak systolic velocity of the aorta and pulmonary arteries. Markers primarily affecting the diastolic function, including the mitral and tricuspid E/A ratio. Markers of global cardiac function, including left and right isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT) ejection time (ET), and myocardial performance index (MPI). Random-effect meta-analyses were used to analyze the data. Results: Fifteen studies were included. Fetuses affected by FGR had a smaller right SI (MD -0.23, 95% CI 0.44 to -0.01; p: 0.04) and left (MD: -0.20, 95% CI -0.33 to -0.05) compared to those not affected. There was no difference in left (p = 0.179) and right (p = 0.068) CO between fetuses affected and those not affected by FGR. Fetuses with FGR had shorter MAPSE (MD: -0.91 mm, 95% CI: -1.25 to -0.57; p < 0.001) and TAPSE (MD: -1.09 mm, 95% CI: -1.23 to -0.96; p < 0.001), while there was no difference in mitral (p = 0.832) and tricuspid (p = 0.504) E/A ratio. Left MPI was higher (MD: 0.09, 95% CI 0.04 to 0.14; p < 0.001) in fetuses with FGR compared with controls. Conclusion: FGR is associated with significant changes in fetal cardiac geometry and function.