期刊
JOURNAL OF CLINICAL MEDICINE
卷 9, 期 9, 页码 -出版社
MDPI
DOI: 10.3390/jcm9092891
关键词
cardiovascular function; cardiac output; Doppler; fetal growth restriction; pre-eclampsia
资金
- Imperial Health Charity [151612]
- National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre [146281]
- Agency for Innovation by Science and Technology (IWT) in Brussels, Belgium, as part of the Limburg Clinical Research Program by the Limburg Clinical Research Center (LCRC)
- Hasselt University
- Ziekenhuis Oost Limburg Genk and Jessa Ziekenhuis Hasselt in the province of Limburg, Belgium [131581]
- Action Medical Research: [2450]
- National Institute for Health Research Comprehensive Biomedical Research Centre at Imperial College Healthcare NHS Trust
- Imperial College London
We investigate the relationship between maternal cardiovascular (CV) function and fetal Doppler changes in healthy pregnancies and those with pre-eclampsia (PE), small for gestational age (SGA) or fetal growth restriction (FGR). This was a three-centre prospective study, where CV assessment was performed using inert gas rebreathing, continuous Doppler or impedance cardiography. Maternal cardiac output (CO) and peripheral vascular resistance (PVR) were analysed in relation to the uterine artery, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI, expressed asz-scores by gestational week) using polynomial regression analyses, and in relation to the presence of absent/reversed end diastolic (ARED) flow in the UA. We included 81 healthy controls, 47 women with PE, 65 with SGA/FGR and 40 with PE + SGA/FGR. Maternal CO was inversely related to fetal UA PI and positively related to MCA PI; the opposite was observed for PVR, which was also positively associated with increased uterine artery impedance. CO was lower (z-score 97,p= 0.02) and PVR higher (z-score 2.88,p= 0.02) with UA ARED flow. We report that maternal CV dysfunction is associated with fetal vascular changes, namely raised impedance in the fetal-placental circulation and low impedance in the fetal cerebral vessels. These findings are most evident with critical UA Doppler changes and represent a potential mechanism for therapeutic intervention.
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