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

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 0370476 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6868 (Electronic) Linking ISSN: 00029378 NLM ISO Abbreviation: Am J Obstet Gynecol Subsets: MEDLINE
    • Publication Information:
      Publication: <2005->: New York : Elsevier
      Original Publication: St. Louis.
    • Subject Terms:
      Ventricular Remodeling*; Cardiomegaly/*epidemiology ; Fetal Growth Retardation/*epidemiology ; Fetal Heart/*diagnostic imaging ; Pre-Eclampsia/*epidemiology ; Ventricular Dysfunction/*epidemiology; Adult ; Cardiomegaly/blood ; Cardiomegaly/diagnostic imaging ; Cardiomegaly/physiopathology ; Echocardiography ; Female ; Fetal Blood ; Fetal Heart/physiopathology ; Gestational Age ; Humans ; Natriuretic Peptide, Brain/blood ; Pregnancy ; Pregnancy Trimester, Third ; Prospective Studies ; Spain/epidemiology ; Troponin I/blood ; Ventricular Dysfunction/blood ; Ventricular Dysfunction/diagnostic imaging ; Ventricular Dysfunction/physiopathology
    • 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 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.
      (Copyright © 2019 Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: Am J Obstet Gynecol. 2020 Feb;222(2):196-197. (PMID: 31697909)
      Comment in: Am J Obstet Gynecol. 2020 Feb;222(2):197. (PMID: 31697911)
      Comment in: Am J Obstet Gynecol. 2020 Mar;222(3):285-286. (PMID: 31816304)
      Comment in: Am J Obstet Gynecol. 2020 Mar;222(3):286-287. (PMID: 31816308)
    • Contributed Indexing:
      Keywords: B-type natriuretic peptide; cardiovascular remodeling; fetal echocardiography; fetal programming; intrauterine growth restriction; pregnancy hypertension; troponin I
    • Accession Number:
      0 (Troponin I)
      114471-18-0 (Natriuretic Peptide, Brain)
    • Publication Date:
      Date Created: 20190724 Date Completed: 20200420 Latest Revision: 20200420
    • Publication Date:
      20221213
    • Accession Number:
      10.1016/j.ajog.2019.07.025
    • Accession Number:
      31336074