The Influence of Intrauterine Environment on Cardiovascular Development During Fetal Life

Research output: ThesisDoctoral Thesis (compilation)


Fetal growth restriction has been linked to later cardiovascular disease, possibly through reduced arterial distensibility in response to a suboptimal intrauterine environment. This thesis sought firstly to examine the relationship between fetal growth and haemodynamics and their effect on later cardiovascular function and secondly to examine the effects of differential volume loading on arterial distensibility in genetically identical monochorionic twins with twin-twin transfusion syndrome (TTTS) and to explore the effect that early treatment has on vascular development. Pulse wave velocity, cardiovascular growth and haemodynamics and the response of heart rate and blood pressure to tilt-testing in infancy were examined in two cohorts of normally grown (N) and growth restricted (GR) fetuses examined serially during fetal life and through the first year of life. Fetal growth restriction was associated with altered vascular behaviour, volume blood flow and increased thickness of cardiac walls, possibly in response to documented increased systemic impedance, but by a year of age no differences were observed. Arterial distensibility was higher in GR during the fetal and neonatal periods but not later in infancy. Heart rate was higher in GR during infancy suggesting increased sympathetic drive and blood pressure showed a trend towards higher values. Abnormal responses to tilt testing were documented in GR individuals who had shown abnormal fetal blood flow Doppler waveforms suggesting a possible influence on later baroreceptor function. Monochorionic twins with TTTS showed discordant arterial distensibility that was not present in monochorionic or dichorionic controls. Early definitive treatment with laser photocoagulation reduced, but did not completely abolish intertwin discordance, suggesting that vasoactive substances produced in response to differential volume loading in TTTS may influence later vascular behaviour despite definitive treatment of the disease process in the second trimester.


  • Helena Gardiner
Research areas and keywords

Subject classification (UKÄ)

  • Obstetrics, Gynecology and Reproductive Medicine


  • reproduktion, sexualitet, andrology, reproduction, sexuality, Obstetrik, gynekologi, Obstetrics, gynaecology, arterial distensibility, twin-twin transfusion, Growth-restriction, Fetal, Cardiovascular Development, andrologi
Original languageEnglish
Awarding Institution
Supervisors/Assistant supervisor
  • [unknown], [unknown], Supervisor, External person
Award date2002 Apr 6
  • Department of Obstetrics and Gynecology, Lund University
Publication statusPublished - 2002
Publication categoryResearch

Bibliographic note

Defence details Date: 2002-04-06 Time: 10:15 Place: Lund University External reviewer(s) Name: Hanson, Mark Title: Prof Affiliation: [unknown] --- Article: I Gardiner HM, Brodszki J, Eriksson A, Maršál K. Ventriculo-vascular interaction in the normal development of the fetal circulation. Early Human Dev 2001;65:97-106II Gardiner HM, Brodszki J, Maršál K. Ventriculo-vascular physiology of the growth restricted fetus. Ultrasound Ob Gyn 2001;18:47-53III Gardiner HM, Brodszki J, Maršál K. Volume Blood Flow estimation in the normal and growth restricted fetus (submitted to Ultrasound in Medicine and Biology)IV Brodszki J, Gardiner HM, Eriksson A, Stale H, Maršál K. Reproducibility of ultrasonic fetal volume blood flow measurements. Clinical Physiology 199818;5:479 – 485.V Gardiner HM, Brodszki J, Maršál K. Cardiovascular adaptation in growth restricted fetuses before and after birth. (submitted, Heart)VI Cheung YF, Taylor MJO, Fisk NM, Redington AN, Gardiner HM. Fetal origins of reduced arterial distensibility in the Donor twin in twin-twin transfusion syndrome. Lancet 2000;355 1157-1178VII Gardiner HM, Taylor MJO, Karatza AA, Huber A, Greenwald SE, Fisk NM, Hecher K. Twin-twin transfusion syndrome: the influence of intrauterine laser-photocoagulation on arterial distensibility in childhood. (under review, Circulation)