1 - Neonatology Unit, Hospital Dona Estefânia and Maternidade Dr. Alfredo da Costa, Unidade de Saúde Local São José, Centro Clínico Académico de Lisboa, Lisbon, Portugal
2 - Medicine of Woman, Childhood and Adolescence Academic Area, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
3 - CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
- Fetal Growth Restriction Meeting. Lisboa 29-30/11/2024 (Mesa redonda)
In order to monitor long-term outcomes and provide secondary prevention, health professionals first need to know what to monitor, that is, what fetal growth restriction (FGR) has programmed during intrauterine life. The diagnosis of FGR should be refined using prenatal data, based on growth deceleration and Doppler blood flow changes. In Europe, placental insufficiency rather than maternal starvation is the most common cause of FGR. Intrauterine mechanisms associated with FGR, involved in the programming of obesity, metabolic and cardiovascular disease, include: direct structural tissue changes due to hypoperfusion, altered metabolic pathways and endocrine expression mediated by epigenetic mechanisms, insulin resistance and prenatal appetite dysregulation secondary to protein-energy deprivation. Secondary prevention, mitigating or avoiding the programmed metabolic and cardiovascular consequences of FGR, should involve general practitioners and primary care nurses in health care centers, private pediatricians, and nutritionists who provide counseling in kindergartens and schools. Surveillance includes monitoring from an early age of body mass index (screening for early adiposity rebound) and blood pressure. Special attention should be given to correction of dietary errors and promotion of a healthy lifestyle, including physical activity. If obesity is present, blood lipid profile and insulin resistance (HOMA) should be assessed.
Palavras Chave: cardiovascular disease; fetal growth restriction; metabolic disease; obesity; prevention; programming