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Published on: June 29, 2013
Maternal hemodynamics at 11-13 weeks of gestation in pregnancies delivering small for gestational age neonates
A Khalil1, D Sodre, A Syngelaki
1Department of Fetal Medicine, Institute for Women's Health, University College London Hospitals, London, UK.
Insights
Early pregnancy markers for small for gestational age (SGA) neonates reveal impaired placentation. Preeclampsia in SGA pregnancies is associated with elevated aortic systolic blood pressure (SBP(Ao)) and augmentation index (AIx-75).
Area of Science:
- Maternal-fetal medicine
- Cardiovascular physiology in pregnancy
- Pregnancy complications
Background:
- Small for gestational age (SGA) neonates are associated with adverse pregnancy outcomes.
- Early detection of pregnancies at risk for SGA and preeclampsia (PE) is crucial.
- Maternal cardiovascular function and placental health markers in early gestation are key indicators.
Purpose of the Study:
- To investigate aortic systolic blood pressure (SBP(Ao)), pulse wave velocity (PWV), and augmentation index (AIx-75) at 11-13 weeks' gestation.
- To compare these markers in pregnancies delivering SGA neonates with and without preeclampsia (PE) against unaffected controls.
- To assess the relationship between early cardiovascular and placental markers and pregnancy outcomes.
Main Methods:
- Maternal history, PWV, AIx-75, SBP(Ao), uterine artery pulsatility index (PI), and PAPP-A were measured at 11-13 weeks' gestation.
- A cohort of pregnancies delivering SGA neonates with PE (n=337), SGA without PE (n=48), and unaffected controls (n=6,429) were analyzed.
- Cardiovascular parameters and placental markers were compared between groups using multiples of the median (MoM).
Main Results:
- In SGA pregnancies without PE, increased uterine artery PI and decreased PAPP-A were observed, but cardiovascular markers (AIx-75, PWV, SBP(Ao)) were not significantly different from controls.
- In SGA pregnancies with PE, elevated AIx-75, SBP(Ao), uterine artery PI, and decreased PAPP-A were found compared to controls.
- Pulse wave velocity (PWV) did not show significant differences in either SGA group compared to unaffected controls.
Conclusions:
- Low PAPP-A and high uterine artery PI at 11-13 weeks' gestation indicate impaired placentation in pregnancies with SGA neonates.
- Elevated SBP(Ao) and AIx-75 are present in early gestation specifically in SGA pregnancies complicated by preeclampsia.
- These findings suggest distinct early hemodynamic profiles for SGA with PE versus SGA without PE, highlighting the role of cardiovascular changes in PE development.
Objective:
To examine aortic systolic blood pressure (SBP(Ao)), pulse wave velocity (PWV) and augmentation index (adjusted to a heart rate of 75 beats per minute, AIx-75) at 11-13 weeks' gestation in pregnancies delivering small for gestational age (SGA) neonates with and without preeclampsia (PE).
Methods:
At 11+0 to 13+6 weeks' gestation, maternal history was recorded and PWV, AIx-75, SBP(Ao), uterine artery pulsatility index (PI) and maternal serum pregnancy-associated plasma protein-A (PAPP-A) were measured. We compared women with (n = 337) and without (n = 48) PE that delivered SGA neonates with unaffected controls (n = 6,429).
Results:
In the SGA group without PE, compared to unaffected controls, there was no significant difference in AIx-75 (1.03 vs. 1.00 multiple of the median, MoM), PWV (0.98 vs. 1.00 MoM) or SBP(Ao) (1.01 vs. 1.00 MoM), but uterine artery PI was increased (1.10 vs. 1.00 MoM) and PAPP-A decreased (0.85 vs. 1.00 MoM). In SGA with PE, compared to unaffected controls, there was increased AIx-75 (1.13 vs. 1.00 MoM), SBP(Ao) (1.09 vs. 1.00 MoM), uterine artery PI (1.40 vs. 1.00 MoM) and decreased PAPP-A (0.72 vs. 1.00 MoM), but no significant difference in PWV (1.05 vs. 1.00 MoM).
Conclusion:
In pregnancies with SGA neonates, impaired placentation is reflected in low PAPP-A and high uterine artery PI at 11-13 weeks' gestation. In the SGA group with PE, but not in those without PE, there is increased SBP(Ao) and AIx-75.
