Correlation between fetal-placental doppler indices and maternal cardiac function in pregnant women with late-Onset preeclampsia or fetal growth restriction.

BACKGROUND

Fetal growth restriction (FGR) and late-onset preeclampsia (late-onset PE) reflect placental dysfunction but exhibit distinct maternal hemodynamics within the “maternal cardiovascular-placental-fetal unit”.

INTRODUCTION

Our objective was to investigate the correlation between fetal-placental Doppler indices and maternal cardiac function in pregnant women with late-onset PE or FGR.

METHODS

A total of 90 pregnant women at 35–39⁺⁶ weeks of gestation were enrolled and divided into three groups: Control ( = 30), FGR ( = 30), and late-onset PE ( = 30). Doppler ultrasonography was used to measure uterine artery pulsatility indices(UtA-PI), umbilical artery pulsatility indices(UA-PI) Z-scores, and middle cerebral artery pulsatility indices(MCA-PI) Z-scores, alongside maternal hemodynamic parameters, including cardiac output (CO), peripheral vascular resistance (PVR), left ventricular mass (LVM), and left atrial anteroposterior diameter (LAAPD).The Kruskal-Wallis test was used to compare characteristics among the three groups. Spearman’s rank correlation analysis was employed to assess relationships between maternal cardiac output/peripheral vascular resistance and fetal-placental Doppler indices in the three subgroups. Partial Spearman rank correlation analysis adjusting for maternal age and BMI was used to evaluate independent associations.

RESULTS

FGR neonates had the lowest birth weights ( < 0.05). The FGR group showed reduced CO, LVM, LAAPD ( < 0.05) but elevated PVR, UtA-PI, UA-PI Z-scores ( < 0.05). Late-onset PE exhibited preserved cardiac function (CO, LVM, LAAPD comparable to controls,  > 0.05) but significantly higher CO, LVM, LAAPD than FGR ( < 0.05). No significant differences in MCA-PI Z-scores were observed across groups. UtA-PI negatively correlated with CO (ρ=−0.396,  < 0.001) but positively with PVR (ρ = 0.371,  < 0.001). UA-PI Z-score negatively correlated with CO (ρ=−0.257,  = 0.015). However, MCA-PI Z-scores showed no correlation with CO and PVR.Notably, 90% of FGR cases clustered in the low-CO/high-UtA-PI quadrant.

CONCLUSIONS

In direct response to our primary aim investigating maternal-fetal hemodynamic coupling, we conclude that: FGR manifests as maternal hemodynamic failure (low-CO/high-UtA-PI) causing placental hypoperfusion; Late-onset PE presents volume overload with preserved uteroplacental function; Dual UtA-PI and CO assessment provides phenotype-specific biomarkers to guide targeted therapy.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12884-025-07848-x.