Masini Giulia, Tay Jasmine, McEniery Carmel M, Wilkinson Ian B, Valensise Herbert, Tiralongo Grazia M, Farsetti Daniele, Gyselaers Wilfried, Vonck Sharona, Lees Christoph C
Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK.
Fetal Medicine Unit, Careggi University Hospital, 50134 Florence, Italy.
J Clin Med. 2020 Sep 7;9(9):2891. doi: 10.3390/jcm9092891.
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 as -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 (-score 97, = 0.02) and PVR higher (-score 2.88, = 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.
我们研究了健康妊娠以及患有先兆子痫（PE）、小于胎龄儿（SGA）或胎儿生长受限（FGR）的妊娠中，母体心血管（CV）功能与胎儿多普勒变化之间的关系。这是一项三中心前瞻性研究，其中使用惰性气体再呼吸、连续多普勒或阻抗心动描记术进行CV评估。使用多项式回归分析，分析母体心输出量（CO）和外周血管阻力（PVR）与子宫动脉、脐动脉（UA）和大脑中动脉（MCA）搏动指数（PI，按孕周表示为z分数）的关系，以及与UA舒张末期血流缺失/反向（ARED）的关系。我们纳入了81名健康对照者、47名患有PE的女性、65名患有SGA/FGR的女性以及40名患有PE + SGA/FGR的女性。母体CO与胎儿UA PI呈负相关，与MCA PI呈正相关；PVR则相反，其也与子宫动脉阻抗增加呈正相关。出现UA ARED血流时，CO较低（z分数97, P = 0.02），PVR较高（z分数2.88, P = 0.02）。我们报告母体CV功能障碍与胎儿血管变化相关，即胎儿 - 胎盘循环阻抗升高和胎儿脑血管阻抗降低。这些发现以关键的UA多普勒变化最为明显，代表了一种潜在的治疗干预机制。
