Gyselaers Wilfried, Lees Christoph
Department of Obstetrics, Ziekenhuis Oost Limburg, Genk, Belgium.
Department of Physiology, Hasselt University, Hasselt, Belgium.
Front Med (Lausanne). 2022 Jun 9;9:902634. doi: 10.3389/fmed.2022.902634. eCollection 2022.
This narrative review summarizes current evidence on the association between maternal low volume circulation and poor fetal growth. Though much work has been devoted to the study of cardiac output and peripheral vascular resistance, a low intravascular volume may explain why high vascular resistance causes hypertension in women with preeclampsia (PE) that is associated with fetal growth restriction (FGR) and, at the same time, presents with normotension in FGR itself. Normotensive women with small for gestational age babies show normal gestational blood volume expansion superimposed upon a constitutionally low intravascular volume. Early onset preeclampsia (EPE; occurring before 32 weeks) is commonly associated with FGR, and poor plasma volume expandability may already be present before conception, thus preceding gestational volume expansion. Experimentally induced low plasma volume in rodents predisposes to poor fetal growth and interventions that enhance plasma volume expansion in FGR have shown beneficial effects on intrauterine fetal condition, prolongation of gestation and birth weight. This review makes the case for elevating the maternal intravascular volume with physical exercise with or without Nitric Oxide Donors in FGR and EPE, and evaluating its role as a potential target for prevention and/or management of these conditions.
这篇叙述性综述总结了目前关于母体低血容量与胎儿生长受限之间关联的证据。尽管已有大量研究致力于心输出量和外周血管阻力的研究，但血管内容量低可能解释了为何高血管阻力会导致子痫前期（PE）女性出现高血压，而子痫前期与胎儿生长受限（FGR）相关，同时，胎儿生长受限本身血压正常。孕周小于胎龄的血压正常女性，其妊娠期血容量正常增加，但基础血管内容量较低。早发型子痫前期（EPE；发生在32周之前）通常与胎儿生长受限相关，血浆容量扩张能力差可能在受孕前就已存在，因此早于妊娠期血容量增加。实验诱导啮齿动物出现低血浆容量会导致胎儿生长受限，而在胎儿生长受限中增强血浆容量扩张的干预措施已显示对宫内胎儿状况、延长孕周和出生体重有有益影响。本综述提出，在胎儿生长受限和早发型子痫前期中，通过体育锻炼或联合一氧化氮供体来提高母体血管内容量，并评估其作为预防和/或管理这些疾病潜在靶点的作用。
