Fetal Growth Restriction: Does an Integrated Maternal Hemodynamic-Placental Model Fit Better?

Area of Science:

• Obstetrics and Gynecology
• Cardiovascular Physiology
• Maternal-Fetal Medicine

Background:

• Adverse pregnancy outcomes (APOs), including preeclampsia (PE) and fetal growth restriction (FGR), are increasingly linked to inadequate maternal hemodynamic adaptations.
• A potential association exists between placental syndromes and later-life maternal cardiovascular diseases (CVD).
• Early-onset FGR and PE may stem from defective placentation, while late-onset FGR might be linked to maternal cardiovascular maladaptation.

Purpose of the Study:

• To review the relationship between maternal cardiac function and placentation in the development of early and late-onset FGR.
• To elucidate the role of maternal cardiovascular system's hemodynamic profile in FGR pathogenesis.
• To highlight the clinical implications of understanding maternal hemodynamics in FGR.

Main Methods:

• Literature review focusing on maternal hemodynamics and placentation in FGR.
• Analysis of pathogenetic pathways for early-onset versus late-onset FGR.
• Synthesis of current understanding of cardiovascular adaptations during pregnancy.

Main Results:

• Defective placentation is implicated in early-onset FGR and PE.
• Late-onset FGR may result from maternal cardiovascular maladaptation, leading to placental hypoperfusion.
• Maternal cardiovascular system's hemodynamic profile significantly influences placental development and fetal growth.

Conclusions:

• Maternal hemodynamics play a critical role in the development of FGR.
• Understanding these hemodynamic adaptations can improve screening and therapeutic strategies for FGR.
• Further research into maternal cardiac function in FGR pregnancies is warranted.