Intrauterine growth restriction is not associated with decreased
exercise capacity in adolescents with congenital heart disease
Andrew D. Spearman MD
Rohit S. Loomba MD
Michael Danduran MS, PhDc
Joshua Kovach MD
Division of Cardiology, Children’s Hospital
of Wisconsin, Medical College of Wisconsin,
Milwaukee, Wisconsin, USA
Division of Cardiology, Cincinnati Children’s
Hospital Medical Center, Ohio, USA
Andrew D. Spearman, Children’s Hospital
of Wisconsin, Medical College of
Wisconsin, 9000 Wisconsin Avenue,
Milwaukee, WI 53226.
Objective: Multiple studies demonstrate the association of intrauterine growth restriction (IUGR)
with impaired aerobic fitness in adolescents and adults. To our knowledge, there are no studies
including individuals with the history of both IUGR and congenital heart disease (CHD). Thus, we
sought to evaluate the impact of IUGR on exercise capacity in adolescents with CHD.
Study Design: We conducted a retrospective chart review of patients <18 years of age who
underwent cardiopulmonary exercise testing (CPET) between August 1, 2003 and July 1, 2016.
Individuals with birth weight <10th percentile for gestational age were defined as IUGR. Patients
with IUGR were matched with non-IUGR patients by cardiac diagnosis and age at CPET. We
excluded patients >18 years of age at time of CPET, those without a documented birth weight,
gestational age, or Race.
Results: A total of 282 patients were included with CHD present in 86 IUGR cases and 86 con-
trols. There was no difference in percent predicted exercise duration (IUGR: 65.2% 6 31.2, non-
IUGR: 67.4% 6 27.2; P 5 .67). Resting heart rate, chronotropic index, percent-predicted peak oxy-
gen consumption, and pulmonary function were similar between groups. Regression analyses
confirmed that IUGR was not independently associated with difference in percent-predicted exer-
Conclusions: Intrauterine growth restriction is not associated with the differences in the measure-
ments of exercise capacity in adolescents with CHD. These findings contrast earlier studies,
showing decreased fitness in individuals with low birth weight but without CHD. To our knowl-
edge, this is the first study to examine the impact of IUGR on exercise capacity in patients with
Bruce protocol, cardiopulmonary exercise testing, congenital heart disease, intrauterine growth
Infants exposed to inadequate delivery of nutrients or oxygen are at
risk for impaired fetal growth, frequently termed intrauterine growth
restriction (IUGR). IUGR is one of the most common pathologies affect-
ing the fetus, occurring in up to 15% of all pregnancies.
Multiple studies demonstrate the association of low birth weight
and IUGR with early and late-onset cardiovascular disease, as well as
dyslipidemia, diabetes mellitus, and metabolic syndrome.
also show the association of IUGR with various measures of impaired
aerobic and anaerobic fitness in adolescents and adults, although other
studies show conflicting findings.
The association of IUGR with
Abbreviations: BMI, body mass index; CHD, congenital heart disease; CPET,
cardiopulmonary exercise testing; IUGR, intrauterine growth restriction.
Congenital Heart Disease. 2018;13:369–376. wileyonlinelibrary.com/journal/chd
2018 Wiley Periodicals, Inc.
Received: 13 July 2017
Revised: 20 November 2017
Accepted: 26 December 2017