Fetal cardiac function at 35-37 weeks' gestation in pregnancies that subsequently develop pre-eclampsia

Area of Science:

• Cardiology
• Obstetrics
• Fetal Medicine

Background:

• Pre-eclampsia (PE) is a significant cause of maternal and fetal morbidity.
• Early detection of PE risk is crucial for timely intervention.
• Fetal cardiac adaptations may serve as early indicators of PE development.

Purpose of the Study:

• To compare fetal cardiac morphology and function in pregnancies that develop pre-eclampsia (PE) versus normotensive pregnancies.
• To investigate associations between fetal cardiac parameters and markers of placental function and fetal well-being.

Main Methods:

• Prospective observational study of 1574 pregnancies (35-37 weeks gestation).
• Comprehensive fetal cardiac assessment using echocardiography and speckle-tracking.
• Measurement of uterine artery pulsatility index, mean arterial pressure (MAP), placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and cerebroplacental ratio (CPR).

Main Results:

• Fetuses in pregnancies developing PE showed reduced right ventricular sphericity and systolic contractility (global longitudinal strain).
• Impaired left ventricular diastolic function (increased E/A ratio) was observed in fetuses of mothers who developed PE.
• Elevated MAP and sFlt-1, with lower PlGF and CPR, were noted in pregnancies that developed PE, indicating placental dysfunction and ischemia preceding clinical onset.

Conclusions:

• Pregnancies that develop PE exhibit distinct fetal cardiac changes, including right and left ventricular dysfunction.
• These cardiac alterations are associated with impaired placentation and placental ischemia, detectable 2-4 weeks before PE diagnosis.
• Fetal cardiac assessment may offer insights into the pathophysiology of PE and potential early detection strategies.