A higher umbilical artery pulsatility index (PI) and umbilical artery PI/cerebral artery PI ratio in the third trimester may be indicative of a child’s future respiratory health, including the child’s risk for early wheezing, according to a study published in Pediatric Allergy and Immunology.

A total of 903 children from The Netherlands were included in the population-based prospective cohort study. Researchers used pulsed-wave-Doppler to measure fetal umbilical, cerebral, and pulmonary blood flow at a median gestational age of 30.3 weeks. Questionnaire data were examined until the age of 6 years to evaluate wheezing patterns (never; early [≤3 years only]; late [>3-6 years]; persistent wheezing) in children. Spirometry identified lung function and questionnaire data helped determine current asthma diagnoses.

There was a nonsignificant association between having a higher umbilical artery PI and umbilical artery PI/cerebral artery PI ratio. This finding correlated with children having a higher risk for early wheezing (odds ratio [OR], 2.07; 95% CI, 0.70-6.10) and for late/persistent wheezing (OR, 1.68; 95% CI, 0.34-6.50 per unit increase in umbilical artery PI). A higher umbilical artery PI/cerebral artery PI ratio was also associated with a higher risk for early wheezing (OR, 2.74; 95% CI, 0.60-12.62). Additionally, there was a higher risk for late/persistent wheezing in patients with a higher pulmonary artery time velocity integral (OR, 1.14; 95% CI, 1.01-1.29 per unit increase).

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Although the middle cerebral artery PI was not associated with patterns of wheezing, it was associated with a higher forced expiratory volume in 1 second/forced vital capacity (Z-score, 0.21; 95% CI, 0.01-0.42) during the third trimester.

Limitations of the study included the reliance on questionnaire data as well as the relatively affluent strictly Dutch cohort, which may have reduced the generalizability of the findings.

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The study investigators concluded that the “findings should be considered as hypothesis generating and need further replication.”


Kooijman MN, van Meel ER, Steegers EAP, et al. Fetal umbilical, cerebral and pulmonary blood flow patterns in relation to lung function and asthma in childhood. The Generation R Study [published online February 23, 2019]. Pediatr Allergy Immunol. doi:10.1111/pai.13044