The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0SW, UK.
Arch Gynecol Obstet. 2023 May;307(5):1431-1439. doi: 10.1007/s00404-022-06635-9. Epub 2022 Jun 3.
To evaluate the relationship between maternal left ventricular systolic function, utero-placental circulation, and risk of adverse neonatal outcomes in women with cardiac disease.
119 women managed in the pregnancy heart clinic (2019-2021) were identified. Women were classified by their primary cardiac condition. Adverse neonatal outcomes were: low birth weight (< 2500 g), small-for-gestational-age (< 10th birth-weight centile), pre-term delivery (< 37 weeks' gestation), and fetal demise (> 20 weeks' gestation). Parameters of left ventricular systolic function (global longitudinal strain, radial strain, ejection fraction, average S', and cardiac output) were calculated and pulsatility index was recorded from last growth scan.
Adverse neonatal outcomes occurred in 28 neonates (24%); most frequently in valvular heart disease (n = 8) and cardiomyopathy (n = 7). Small-for-gestational-age neonates were most common in women with cardiomyopathy (p = 0.016). Early pregnancy average S' (p = 0.03), late pregnancy average S' (p = 0.02), and late pregnancy cardiac output (p = 0.008) were significantly lower in women with adverse neonatal outcomes than in those with healthy neonates. There was a significant association between neonatal birth-weight centile and global longitudinal strain (p = 0.04) and cardiac output (p = 0.0002) in late pregnancy. Pulsatility index was highest in women with cardiomyopathy (p = 0.007), and correlated with average S' (p < 0.0001) and global longitudinal strain (p = 0.03) in late pregnancy.
Women with cardiac disease may not tolerate cardiovascular adaptations required during pregnancy to support fetal growth. Adverse neonatal outcomes were associated with reduced left ventricular systolic function and higher pulsatility index. The association between impaired systolic function and reduced fetal growth is supported by insufficient utero-placental circulation.
评估患有心脏病的女性左心室收缩功能、子宫胎盘循环与不良新生儿结局风险之间的关系。
在妊娠心脏诊所（2019-2021 年）中确定了 119 名女性。根据主要心脏状况对女性进行分类。不良新生儿结局包括：低出生体重（<2500 克）、小于胎龄儿（<第 10 个出生体重百分位数）、早产（<37 周妊娠）和胎儿死亡（>20 周妊娠）。计算了左心室收缩功能（整体纵向应变、径向应变、射血分数、平均 S'和心输出量）参数，并从最后一次生长扫描中记录了搏动指数。
28 名新生儿（24%）出现不良新生儿结局；最常见于瓣膜性心脏病（n=8）和心肌病（n=7）。在患有心肌病的女性中，小于胎龄儿最为常见（p=0.016）。早期妊娠平均 S'（p=0.03）、晚期妊娠平均 S'（p=0.02）和晚期妊娠心输出量（p=0.008）在出现不良新生儿结局的女性中明显低于健康新生儿。晚期妊娠时，新生儿出生体重百分位数与整体纵向应变（p=0.04）和心输出量（p=0.0002）呈显著相关。在患有心肌病的女性中，搏动指数最高（p=0.007），与晚期妊娠平均 S'（p<0.0001）和整体纵向应变（p=0.03）呈正相关。
患有心脏病的女性可能无法耐受妊娠期间支持胎儿生长所需的心血管适应。不良新生儿结局与左心室收缩功能降低和搏动指数升高有关。左心室收缩功能受损与胎儿生长减少之间的关联得到了子宫胎盘循环不足的支持。
