Persistent subclinical myocardial dysfunction among infants with Fetal growth restriction at one year of age

Q: What are the key findings of this study?

Fetal growth restriction resulted in persistently impaired left ventricular global longitudinal strain at 12 months (-21.5% early-onset, -22.15% late-onset vs -26.35% controls, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Fetal growth restriction (n=150). Intervention: Fetal growth restriction (early-onset and late-onset) vs. Appropriate-for-gestational-age (AGA) neonates. Primary outcome: Left ventricular global average longitudinal strain (%) at 12 months (p=<0.001).

Q: What does this research mean for the field?

Infants with fetal growth restriction exhibit persistent subclinical myocardial dysfunction, including impaired global longitudinal strain, at one year of age despite somatic catch-up growth and normalization of cardiac dimensions. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate serial longitudinal changes in cardiac structure and function during the first year of life in infants born with fetal growth restriction.

Vidya Nayak; Jyothi Samanth; Krishnananda Nayak; Leslie Lewis; A.J. Ashwal; Rashmi K S; Reshma Nayak; Veekshitha Naik; Swathi M Poojary

doi:10.1038/s41390-026-05429-y

October 28, 2026Pediatric ResearchOpen Access

Persistent subclinical myocardial dysfunction among infants with Fetal growth restriction at one year of age

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Key result

Fetal growth restriction is linked to ~5-point worse infant LV global longitudinal strain at 12 months.

P<0.001
n=150

Why the study?

Fetal growth restriction is associated with altered cardiac development and subclinical myocardial dysfunction, but longitudinal data evaluating serial changes in cardiac structure and function during infancy are limited.

Does fetal growth restriction (early-onset and late-onset) result in persistent subclinical myocardial dysfunction on speckle-tracking echocardiography at 12 months of age compared to appropriate-for-gestational-age infants?

Key Points

To evaluate serial longitudinal changes in cardiac structure and function during the first year of life in infants born with fetal growth restriction.
Prospective longitudinal study enrolling 128 neonates with fetal growth restriction (64 early-onset and 64 late-onset) and 64 appropriate-for-gestational-age controls, with 39 early-onset, 47 late-onset, and 64 control infants completing 1-year follow-up.
Conducted serial cardiac evaluations within the first week of life and at 6 and 12 months using conventional echocardiography, tissue Doppler imaging, and speckle-tracking echocardiography.
By 12 months, cardiac dimensions normalized, including left ventricular end-diastolic dimension (AGA: 26.37 ± 3.87 mm vs EOFGR: 25.07 ± 2.33 mm and LOFGR: 25.44 ± 2.0 mm; p = 0.075), though left ventricular ejection fraction remained lower in FGR infants (AGA: 70.92 ± 2.476% vs EOFGR: 68.3 ± 3.32% and LOFGR: 69.09 ± 2.56%; p = 0.006).
Speckle-tracking echocardiography revealed persistent subclinical myocardial dysfunction, with global longitudinal strain and strain rate indices remaining significantly impaired throughout the 12-month follow-up.
Right ventricular dysfunction emerged by 12 months of age, with reduced right ventricular global longitudinal strain observed particularly in the early-onset growth restriction group.

Study Design

Type

Cohort (n=150)

Multicenter

No

Structured PICO

Does fetal growth restriction (early-onset and late-onset) result in persistent subclinical myocardial dysfunction on speckle-tracking echocardiography at 12 months of age compared to appropriate-for-gestational-age infants?

P

Population

150 neonates in India (39 early-onset FGR, 47 late-onset FGR, and 64 gestational age-matched appropriate-for-gestational-age controls), free of complex congenital heart disease or chromosomal abnormalities, followed from birth to 12 months of age.

E

Exposure

Serial echocardiographic evaluation including conventional echocardiography, tissue Doppler imaging (TDI), and 2D speckle-tracking echocardiography (STE) at birth (within first week of life), 6 months, and 12 months of age in early-onset and late-onset FGR infants.

C

Comparator

64 healthy appropriate-for-gestational-age (AGA) neonates with normal antenatal histories and birth weights between the 10th and 90th percentiles, matched to FGR cases by gestational age at delivery.

O

Outcome

Serial changes in cardiac structure (LV dimensions, wall thickness) and function, specifically subclinical myocardial deformation parameters (global longitudinal strain [GLS] and systolic, early diastolic, and late diastolic strain rates) assessed via conventional echocardiography, tissue Doppler imaging, and speckle-tracking echocardiography at birth, 6 months, and 12 months of age.surrogate

Main Result

Absolute Event Rate: -21.5% vs -26.35%

p-value: p=<0.001

Infants with fetal growth restriction exhibit persistent subclinical left and right ventricular myocardial deformation abnormalities on speckle-tracking echocardiography at 1 year of age despite catch-up growth and apparent normalization of conventional echocardiographic dimensions.

Limitations

Attrition during the 12-month follow-up (42 of 128 enrolled FGR neonates lost to follow-up) may have introduced selection bias
Single-centre study design limiting generalizability to other populations
Detailed maternal and perinatal covariates were not collected for adjusted analyses
Potential residual confounding from unmeasured factors such as feeding patterns and postnatal growth trajectories
Prenatal fetal echocardiography was not performed
Stroke volume was not directly measured
Follow-up limited to 12 months, leaving persistence beyond infancy unknown

Implication

May support serial echocardiography in FGR infants; leaves open prognostic value for later cardiovascular events.

Abstract

Background Fetal growth restriction (FGR) is associated with altered cardiac development and subclinical myocardial dysfunction; however, longitudinal data during infancy are limited. This study evaluated serial changes in cardiac structure and function in infants with FGR during the first year of life. Methods This prospective longitudinal study included 128 FGR neonates and 64 appropriate-for-gestational-age (AGA) neonates, of whom 39 early-onset FGR (EOFGR), 47 late-onset FGR (LOFGR), and 64 AGA neonates completed the 1-year follow-up. FGR was diagnosed antenatally using estimated fetal weight <10th percentile with abnormal Doppler findings and confirmed postnatally using Intergrowth-21 standards. Cardiac evaluation included conventional echocardiography, tissue Doppler imaging, and speckle-tracking echocardiography. Results At birth, FGR infants showed significantly lower anthropometric parameters and smaller cardiac dimensions compared with AGA controls. By 12 months, both FGR groups demonstrated catch-up growth with normalization of left ventricular dimensions and wall thickness. However, speckle-tracking analysis revealed persistent subclinical myocardial dysfunction. Global longitudinal strain and strain rate indices remained significantly impaired across follow-up. Right ventricular dysfunction was evident at 12 months, particularly in the EOFGR group. Conclusion Despite structural normalization and catch-up growth, infants with FGR exhibit persistent subclinical myocardial dysfunction during the first year of life. Impact Infants with fetal growth restriction exhibit reduced cardiac size and altered myocardial function at birth compared to AGA neonates. Both early- and late-onset FGR infants demonstrate significant catch-up growth and cardiac structural normalization by 12 months. Despite normalization of cardiac dimensions, speckle-tracking parameters (GLS and strain rates) remain impaired throughout infancy. Right ventricular dysfunction becomes evident by 12 months, particularly in early-onset FGR infants. Early myocardial impairment in FGR infants may represent a precursor to future cardiovascular risk, highlighting the need for longitudinal cardiac surveillance.

Discussion

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Cite This Study

Nayak et al. (2026) conducted a cohort in Fetal growth restriction (n=150). Fetal growth restriction (early-onset and late-onset) vs. Appropriate-for-gestational-age (AGA) neonates was evaluated on Left ventricular global average longitudinal strain (%) at 12 months (p=<0.001). Fetal growth restriction resulted in persistently impaired left ventricular global longitudinal strain at 12 months (-21.5% early-onset, -22.15% late-onset vs -26.35% controls, p<0.001).

synapsesocial.com/papers/6ae585564c46c197bbab3e0c https://doi.org/10.1038/s41390-026-05429-y

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Persistent subclinical myocardial dysfunction among infants with Fetal growth restriction at one year of age

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Persistent subclinical myocardial dysfunction among infants with Fetal growth restriction at one year of age

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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