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Severe early-onset PE with or without FGR in Chinese women
Hong Shen1, Xueya Zhao2, Juan Li3
1Obstetrics Department, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
This study identified maternal risk factors for fetal growth restriction (FGR) in early-onset preeclampsia (PE). Lower pre-pregnancy BMI and anemia were protective, while low albumin and abnormal uric acid increased FGR risk in PE patients.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatal Research
Background:
- Early-onset preeclampsia (PE) is a severe pregnancy complication with significant perinatal risks.
- Fetal growth restriction (FGR) is a common complication in early-onset PE, necessitating identification of associated risk factors.
- Understanding these factors is crucial for improving clinical management and outcomes.
Purpose of the Study:
- To compare PE severity, laboratory findings, and placental pathology between early-onset PE with FGR and PE with appropriate gestational age (AGA) neonates.
- To identify potential maternal risk factors associated with FGR in early-onset PE.
- To provide insights for clinical diagnosis and treatment of early-onset PE with FGR.
Main Methods:
- Retrospective case study of 276 patients with severe early-onset PE.
- Patients divided into PE with FGR (PE+FGR) and PE with AGA (PE+AGA) groups.
- Clinical data and placental pathology examinations were analyzed to compare differences between groups.
Main Results:
- Lower pre-pregnancy BMI and lower rates of anemia were observed in the PE+FGR group compared to PE+AGA.
- Higher rates of severe low serum albumin were found in the PE+FGR group.
- Severe low serum albumin and abnormal uric acid levels were positively correlated with FGR incidence, while pre-pregnancy BMI and anemia showed a negative correlation. Chronic villitis in placental examinations was also positively correlated with FGR.
Conclusions:
- Maternal pre-pregnancy BMI, anemia, serum albumin, and uric acid levels are significantly associated with FGR in early-onset PE.
- Placental pathology, specifically chronic villitis, is linked to FGR in this population.
- These findings offer valuable perspectives for the clinical diagnosis and management of early-onset PE with FGR.
Abstract:
Early-onset preeclampsia (PE) is a severe condition with highest risk of perinatal complications. In current study, we compared PE severity, laboratory results and placental pathological lesions between early-onset PE with fetal growth restriction (PE + FGR) and appropriate gestational age (PE + AGA) neonates, with the aim to identify potential maternal risk factors associated with FGR. A retrospective case study was conducted in 304 PE women, and 31 cases with mild PE were excluded. 276 patients with severe PE were divided into PE + FGR (163, 59.1%) and PE + AGA (113, 40.9%) groups and underwent clinical analysis. 244 cases were further submitted for pathologic examinations to compare the differences of placental lesions between these two groups. As compared to PE + AGA, the maternal pre-pregnancy BMI (P = 0.003) and the rate of anemia (P = 0.004) were lower in PE + FGR; while the rate of severe low serum albumin (P = 0.020) was higher. Moreover, severe low serum albumin level (aOR = 2.43, P = 0.046) and abnormal uric acid (aOR = 2.19, P = 0.033) were positively correlated to the incidence of FGR, while pre-pregnancy BMI (aOR = 0.39, P = 0.001) and anemia (aOR = 0.33, P = 0.001) showed negative correlation. The placental examinations further showed positively correlation between chronic villitis (aOR = 4.32, P = 0.028) and FGR. Surprisingly, general measures of maternal illness severity failed to present any significant correlation to FGR, except for blood pressure, which showed negative correlation. For the first time, we studied a relatively large case series of Chinses early-onset PE women, and identified multiple factors associated with FGR incidence. Our study provided some opinions on clinal diagnosis and treatment for early-onset PE with FGR.
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