Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy.
Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Ultrasound Obstet Gynecol. 2019 Dec;54(6):732-739. doi: 10.1002/uog.20118. Epub 2019 Nov 11.
To evaluate the association between fetal growth restriction (FGR) and maternal hemodynamic parameters using multivariable analysis, adjusting for major confounding factors, such as hypertensive disorders of pregnancy (pre-eclampsia and gestational hypertension).
A prospective cohort study was conducted between January 2013 and April 2016. Two cohorts of patients were recruited, between 24 and 39 weeks of gestation, in a high-risk outpatient setting. These cohorts comprised 49 appropriate-for-gestational-age singleton fetuses and 93 that were FGR (abdominal circumference (AC) at recruitment in the second half of pregnancy ≤ 10 percentile with a previous normal AC at 20-22 weeks). Maternal echocardiography was performed at the time of enrolment and included hemodynamic parameters of systolic and diastolic function and cardiac remodeling indices. Data were analyzed using a multivariable generalized linear model to estimate the association of FGR with maternal hemodynamic parameters after adjusting for significant confounding factors.
In the multivariable analysis, after adjustment for hypertensive disorders of pregnancy and smoking, FGR was associated with a 14% increase in maternal total vascular resistance, 16% reduction in cardiac output, 13% reduction in left ventricular mass and 11% reduction in heart rate; similar results were observed for the corresponding indexed parameters. Hypertensive disorders of pregnancy in the absence of FGR were associated with a 25% increase in total vascular resistance, 16% increase in left ventricular mass and 14% reduction in diastolic function; similar results were observed for the corresponding indexed parameters.
FGR is significantly and independently associated with several maternal hemodynamic parameters, even after adjustment for major confounding factors, such as hypertensive disorders of pregnancy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
使用多变量分析评估胎儿生长受限（FGR）与母体血液动力学参数之间的关联，调整包括妊娠高血压疾病（子痫前期和妊娠期高血压）在内的主要混杂因素。
这是一项前瞻性队列研究，于 2013 年 1 月至 2016 年 4 月进行。在高危门诊环境中招募了 24 至 39 孕周的两组患者。这两组分别包括 49 名适合胎龄的单胎胎儿和 93 名 FGR 胎儿（在妊娠后半期招募时腹部周长（AC）≤第 10 百分位，且 20-22 周时的 AC 正常）。在入组时对产妇进行超声心动图检查，包括收缩和舒张功能的血液动力学参数以及心脏重构指数。使用多变量广义线性模型分析数据，以在调整了显著混杂因素后，估计 FGR 与母体血液动力学参数之间的关联。
在多变量分析中，在调整了妊娠高血压疾病和吸烟因素后，FGR 与母体总血管阻力增加 14%、心输出量减少 16%、左心室质量减少 13%、心率减少 11%相关；相应的指数参数也有类似的结果。无 FGR 的妊娠高血压疾病与总血管阻力增加 25%、左心室质量增加 16%、舒张功能减少 14%相关；相应的指数参数也有类似的结果。
即使在调整了包括妊娠高血压疾病在内的主要混杂因素后，FGR 与母体血液动力学参数之间也存在显著的独立关联。版权所有 © 2018 ISUOG。由 John Wiley & Sons Ltd 出版。
