Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.
Department of Neonatology, University of Parma, Parma, Italy.
Acta Obstet Gynecol Scand. 2021 May;100(5):876-883. doi: 10.1111/aogs.14026. Epub 2020 Nov 29.
Fetal growth restriction (FGR) in most instances is a consequence of primary placental dysfunction due to inadequate trophoblastic invasion. Maternal cardiac maladaptation to pregnancy has been proposed as a possible determinant of placental insufficiency and impaired fetal growth. This study aimed to compare the maternal hemodynamic parameters between normotensive women with small-for-gestational-age (SGA) and FGR fetuses and to evaluate their correlation with neonatal outcome.
An observational cohort study including singleton pregnancies referred to our tertiary care center due to fetal smallness. At the time of diagnosis, fetuses were classified as SGA or FGR according to the Delphi consensus criteria, and pregnant women underwent hemodynamic assessment using a cardiac output monitor. A group of women with singleton uncomplicated pregnancies ar ≥35 weeks of gestation were recruited as controls. Cardiac output, systemic vascular resistance, stroke volume, and heart rate were measured and compared among the three groups (controls vs FGR vs SGA). The correlation between antenatal findings and neonatal outcome was also evaluated by multivariate logistic regression analysis.
A total of 51 women with fetal smallness were assessed at 34.8 ± 2.6 weeks. SGA and FGR were diagnosed in 22 and 29 cases, respectively. The control group included 61 women assessed at 36.5 ± 0.8 weeks of gestation. Women with FGR had a lower cardiac output Z-score (respectively, -1.3 ± 1.2 vs -0.4 ± 0.8 vs -0.2 ± 1.0; P < .001) and a higher systemic vascular resistance Z-score (respectively, 1.2 ± 1.2 vs 0.2 ± 1.1 vs -0.02 ± 1.2; P < .001) compared with both SGA and controls, whereas no difference in the hemodynamic parameters was found between women with SGA and controls. The incidence of neonatal intensive care unit admission did not differ between SGA and FGR fetuses (18.2% vs 41.4%; P = .13), but FGR fetuses had a longer hospitalization compared with SGA fetuses (14.2 ± 17.7 vs 4.5 ± 1.6 days; P = .02). Multivariate analysis showed that the cardiac output Z-score at diagnosis (P = .012) and the birthweight Z-score (P = .007) were independent predictors of the length of neonatal hospitalization.
Different maternal hemodynamic profiles characterize women with SGA or FGR fetuses. Furthermore, a negative correlation was found between the maternal cardiac output and the length of neonatal hospitalization.
大多数情况下，胎儿生长受限（FGR）是由于胎盘滋养层侵入不足导致原发性胎盘功能障碍的结果。母体对妊娠的心脏适应性不良被认为是胎盘功能不全和胎儿生长受损的一个可能决定因素。本研究旨在比较正常血压孕妇与胎儿生长受限（FGR）和小于胎龄儿（SGA）胎儿的母体血液动力学参数，并评估其与新生儿结局的相关性。
一项观察性队列研究，纳入了因胎儿生长受限而转诊至我们的三级医疗中心的单胎妊娠。在诊断时，根据德尔福共识标准将胎儿分为 SGA 或 FGR，孕妇使用心输出量监测仪进行血液动力学评估。招募了一组 35 周以上单胎无并发症妊娠的妇女作为对照组。测量并比较三组（对照组 vs FGR vs SGA）的心输出量、全身血管阻力、每搏量和心率。还通过多元逻辑回归分析评估了产前发现与新生儿结局的相关性。
共评估了 51 例胎儿生长受限的孕妇，平均孕龄为 34.8±2.6 周。分别诊断出 SGA 和 FGR 各 22 例和 29 例。对照组包括 61 例在 36.5±0.8 周评估的孕妇。FGR 组的心脏输出量 Z 评分较低（分别为-1.3±1.2 与-0.4±0.8 与-0.2±1.0；P<0.001），全身血管阻力 Z 评分较高（分别为 1.2±1.2 与 0.2±1.1 与-0.02±1.2；P<0.001），与 SGA 组和对照组相比，而 SGA 组和对照组之间的血液动力学参数无差异。SGA 组和 FGR 组新生儿入住重症监护病房的发生率无差异（分别为 18.2%和 41.4%；P=0.13），但 FGR 组的住院时间长于 SGA 组（分别为 14.2±17.7 与 4.5±1.6 天；P=0.02）。多因素分析显示，诊断时的心脏输出量 Z 评分（P=0.012）和出生体重 Z 评分（P=0.007）是新生儿住院时间的独立预测因素。
不同的母体血液动力学特征可区分 SGA 或 FGR 胎儿的孕妇。此外，母体心输出量与新生儿住院时间呈负相关。
