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Published on: June 29, 2013
Hemodynamic changes in pregnancies with impaired fetal growth: A systematic review and meta-analysis
Britt M J G Kempener1, Laura M Jorissen1,2, Eva G Mulder2
1Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
Insights
Pregnancies with impaired fetal growth show higher total peripheral vascular resistance (TPVR) and lower cardiac output (CO) from the second trimester. Severe cases, especially with placental issues, have the most pronounced hemodynamic changes.
Area of Science:
- Cardiovascular Physiology
- Reproductive Medicine
- Fetal Development
Background:
- Central hemodynamic abnormalities may precede impaired fetal growth.
- Understanding cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories is crucial.
Purpose of the Study:
- To assess cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories in singleton pregnancies with and without impaired fetal growth.
- To conduct a systematic review and meta-analysis of existing studies.
Main Methods:
- Systematic search of PubMed and Embase databases (inception - July 2023).
- Inclusion of studies reporting CO and TPVR in pregnancies with impaired fetal growth, excluding those with pre-existing hypertension or cardiac disease.
- Meta-analysis using a random-effects model to calculate absolute hemodynamic values and subgroup analyses for severe phenotypes.
Main Results:
- Thirty-three studies involving 7816 women were analyzed.
- No difference in non-pregnant hemodynamic function was observed between groups.
- Impaired fetal growth was associated with elevated second and third-trimester TPVR and reduced third-trimester CO.
- Higher TPVR was noted in more severe fetal growth restriction phenotypes.
Conclusions:
- Impaired fetal growth is linked to increased vascular resistance and reduced CO starting in the second trimester.
- More severe fetal growth restriction phenotypes exhibit a more vasoconstrictive hemodynamic profile.
- Future research should explore preventive measures to normalize hemodynamic function.
Introduction:
Abnormalities in central hemodynamic functions before and throughout pregnancy may antedate impaired fetal growth. We aimed to assess cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories throughout singleton pregnancies with and without impaired fetal growth by systematic review and meta-analysis.
Material And Methods:
PubMed and Embase were systematically searched (inception - July 2023), and reference lists were screened. Studies reporting CO and TPVR during singleton pregnancies complicated by impaired fetal growth were included. Studies measuring hemodynamic parameters in women with prepregnancy hypertension and/or cardiac diseases were excluded. Absolute values of hemodynamic parameters were calculated over pregnancy using a random-effects model, and subgroup analyses differentiated more severe clinical phenotypes of impaired fetal growth. The systematic review was registered in the PROSPERO database (CRD42020172252).
Results:
Thirty-three studies were included, comprising 7816 women. Hemodynamic function in non-pregnant women did not differ between those who subsequently gave birth to a growth-restricted neonate or an appropriately grown neonate. Pregnancies complicated by impaired fetal growth were accompanied by elevated second and third-trimester TPVR and concurrent reduced third-trimester CO. Second and third-trimester TPVR was consistently higher when fetal growth restriction was accompanied by abnormal perfusion indices instead of only low birthweight (centile), concurrent maternal hypertensive disorder of pregnancy, and when small for gestational age was accompanied by preterm birth.
Conclusions:
Impaired fetal growth is associated with increased vascular resistance and reduced CO from the second trimester onwards. More severe phenotypes, particularly those with attenuated placental perfusion or lower gestational age at birth, exhibit the most vasoconstrictive hemodynamic profile. Future studies could focus on targeted preventive measures to restore hemodynamic function.
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