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Fetal cardiac remodeling and dysfunction is associated with both preeclampsia and fetal growth restriction

Youssef, Lina LU orcid ; Miranda, Jezid ; Paules, Cristina ; Garcia-Otero, Laura ; Vellvé, Kilian ; Kalapotharakos, Grigorios LU ; Sepulveda-Martinez, Alvaro ; Crovetto, Francesca ; Gomez, Olga and Gratacós, Eduard , et al. (2020) In American Journal of Obstetrics and Gynecology 222(1). p.1-79
Abstract

Background: Preeclampsia and fetal growth restriction share some pathophysiologic features and are both associated with placental insufficiency. Fetal cardiac remodeling has been described extensively in fetal growth restriction, whereas little is known about preeclampsia with a normally grown fetus. Objective: To describe fetal cardiac structure and function in pregnancies complicated by preeclampsia and/or fetal growth restriction as compared with uncomplicated pregnancies. Study design: This was a prospective, observational study including pregnancies complicated by normotensive fetal growth restriction (n=36), preeclampsia with a normally grown fetus (n=35), preeclampsia with fetal growth restriction (preeclampsia with a normally... (More)

Background: Preeclampsia and fetal growth restriction share some pathophysiologic features and are both associated with placental insufficiency. Fetal cardiac remodeling has been described extensively in fetal growth restriction, whereas little is known about preeclampsia with a normally grown fetus. Objective: To describe fetal cardiac structure and function in pregnancies complicated by preeclampsia and/or fetal growth restriction as compared with uncomplicated pregnancies. Study design: This was a prospective, observational study including pregnancies complicated by normotensive fetal growth restriction (n=36), preeclampsia with a normally grown fetus (n=35), preeclampsia with fetal growth restriction (preeclampsia with a normally grown fetus–fetal growth restriction, n=42), and 111 uncomplicated pregnancies matched by gestational age at ultrasound. Fetal echocardiography was performed at diagnosis for cases and recruitment for uncomplicated pregnancies. Cord blood concentrations of B-type natriuretic peptide and troponin I were measured at delivery. Univariate and multiple regression analysis were conducted. Results: Pregnancies complicated by preeclampsia and/or fetal growth restriction showed similar patterns of fetal cardiac remodeling with larger hearts (cardiothoracic ratio, median [interquartile range]: uncomplicated pregnancies 0.27 [0.23–0.29], fetal growth restriction 0.31 [0.26–0.34], preeclampsia with a normally grown fetus 0.31 [0.29–0.33), and preeclampsia with fetal growth restriction 0.28 [0.26–0.33]; P<.001) and more spherical right ventricles (right ventricular sphericity index: uncomplicated pregnancies 1.42 [1.25–1.72], fetal growth restriction 1.29 [1.22–1.72], preeclampsia with a normally grown fetus 1.30 [1.33–1.51], and preeclampsia with fetal growth restriction 1.35 [1.27–1.46]; P=.04) and hypertrophic ventricles (relative wall thickness: uncomplicated pregnancies 0.55 [0.48–0.61], fetal growth restriction 0.67 [0.58–0.8], preeclampsia with a normally grown fetus 0.68 [0.61–0.76], and preeclampsia with fetal growth restriction 0.66 [0.58–0.77]; P<.001). Signs of myocardial dysfunction also were observed, with increased myocardial performance index (uncomplicated pregnancies 0.78 z scores [0.32–1.41], fetal growth restriction 1.48 [0.97–2.08], preeclampsia with a normally grown fetus 1.15 [0.75–2.17], and preeclampsia with fetal growth restriction 0.45 [0.54–1.94]; P<.001) and greater cord blood B-type natriuretic peptide (uncomplicated pregnancies 14.2 [8.4–30.9] pg/mL, fetal growth restriction 20.8 [13.1–33.5] pg/mL, preeclampsia with a normally grown fetus 31.8 [16.4–45.8] pg/mL and preeclampsia with fetal growth restriction 37.9 [15.7–105.4] pg/mL; P<.001) and troponin I as compared with uncomplicated pregnancies. Conclusion: Fetuses of preeclamptic mothers, independently of their growth patterns, presented cardiovascular remodeling and dysfunction in a similar fashion to what has been previously described for fetal growth restriction. Future research is warranted to better elucidate the mechanism(s) underlying fetal cardiac adaptation in these conditions.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
B-type natriuretic peptide, cardiovascular remodeling, fetal echocardiography, fetal programming, intrauterine growth restriction, pregnancy hypertension, troponin I
in
American Journal of Obstetrics and Gynecology
volume
222
issue
1
pages
1 - 79
publisher
Elsevier
external identifiers
  • pmid:31336074
  • scopus:85070783101
ISSN
0002-9378
DOI
10.1016/j.ajog.2019.07.025
language
English
LU publication?
yes
id
69d452be-7c20-440d-a203-0ae23b8c9611
date added to LUP
2019-09-09 11:31:20
date last changed
2024-06-26 01:27:54
@article{69d452be-7c20-440d-a203-0ae23b8c9611,
  abstract     = {{<p>Background: Preeclampsia and fetal growth restriction share some pathophysiologic features and are both associated with placental insufficiency. Fetal cardiac remodeling has been described extensively in fetal growth restriction, whereas little is known about preeclampsia with a normally grown fetus. Objective: To describe fetal cardiac structure and function in pregnancies complicated by preeclampsia and/or fetal growth restriction as compared with uncomplicated pregnancies. Study design: This was a prospective, observational study including pregnancies complicated by normotensive fetal growth restriction (n=36), preeclampsia with a normally grown fetus (n=35), preeclampsia with fetal growth restriction (preeclampsia with a normally grown fetus–fetal growth restriction, n=42), and 111 uncomplicated pregnancies matched by gestational age at ultrasound. Fetal echocardiography was performed at diagnosis for cases and recruitment for uncomplicated pregnancies. Cord blood concentrations of B-type natriuretic peptide and troponin I were measured at delivery. Univariate and multiple regression analysis were conducted. Results: Pregnancies complicated by preeclampsia and/or fetal growth restriction showed similar patterns of fetal cardiac remodeling with larger hearts (cardiothoracic ratio, median [interquartile range]: uncomplicated pregnancies 0.27 [0.23–0.29], fetal growth restriction 0.31 [0.26–0.34], preeclampsia with a normally grown fetus 0.31 [0.29–0.33), and preeclampsia with fetal growth restriction 0.28 [0.26–0.33]; P&lt;.001) and more spherical right ventricles (right ventricular sphericity index: uncomplicated pregnancies 1.42 [1.25–1.72], fetal growth restriction 1.29 [1.22–1.72], preeclampsia with a normally grown fetus 1.30 [1.33–1.51], and preeclampsia with fetal growth restriction 1.35 [1.27–1.46]; P=.04) and hypertrophic ventricles (relative wall thickness: uncomplicated pregnancies 0.55 [0.48–0.61], fetal growth restriction 0.67 [0.58–0.8], preeclampsia with a normally grown fetus 0.68 [0.61–0.76], and preeclampsia with fetal growth restriction 0.66 [0.58–0.77]; P&lt;.001). Signs of myocardial dysfunction also were observed, with increased myocardial performance index (uncomplicated pregnancies 0.78 z scores [0.32–1.41], fetal growth restriction 1.48 [0.97–2.08], preeclampsia with a normally grown fetus 1.15 [0.75–2.17], and preeclampsia with fetal growth restriction 0.45 [0.54–1.94]; P&lt;.001) and greater cord blood B-type natriuretic peptide (uncomplicated pregnancies 14.2 [8.4–30.9] pg/mL, fetal growth restriction 20.8 [13.1–33.5] pg/mL, preeclampsia with a normally grown fetus 31.8 [16.4–45.8] pg/mL and preeclampsia with fetal growth restriction 37.9 [15.7–105.4] pg/mL; P&lt;.001) and troponin I as compared with uncomplicated pregnancies. Conclusion: Fetuses of preeclamptic mothers, independently of their growth patterns, presented cardiovascular remodeling and dysfunction in a similar fashion to what has been previously described for fetal growth restriction. Future research is warranted to better elucidate the mechanism(s) underlying fetal cardiac adaptation in these conditions.</p>}},
  author       = {{Youssef, Lina and Miranda, Jezid and Paules, Cristina and Garcia-Otero, Laura and Vellvé, Kilian and Kalapotharakos, Grigorios and Sepulveda-Martinez, Alvaro and Crovetto, Francesca and Gomez, Olga and Gratacós, Eduard and Crispi, Fatima}},
  issn         = {{0002-9378}},
  keywords     = {{B-type natriuretic peptide; cardiovascular remodeling; fetal echocardiography; fetal programming; intrauterine growth restriction; pregnancy hypertension; troponin I}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{1--79}},
  publisher    = {{Elsevier}},
  series       = {{American Journal of Obstetrics and Gynecology}},
  title        = {{Fetal cardiac remodeling and dysfunction is associated with both preeclampsia and fetal growth restriction}},
  url          = {{http://dx.doi.org/10.1016/j.ajog.2019.07.025}},
  doi          = {{10.1016/j.ajog.2019.07.025}},
  volume       = {{222}},
  year         = {{2020}},
}