妊娠高血圧症候群における母体循環と新生児循環の関連性

Hypertensive disorders of pregnancy (HDP), particularly early-onset preeclampsia (EOPE), are major causes of perinatal morbidity and mortality. While impaired placentation has long been recognized as a key mechanism, increasing evidence highlights the contribution of maternal cardiovascular dysfunction. However, how maternal haemodynamics influences neonatal circulatory transition remains poorly understood. In this prospective study, mother-infant pairs from pregnancies complicated by EOPE were enrolled if the mother had undergone echocardiographic assessment within three weeks prior to delivery and the neonate had received continuous hemodynamic monitoring by electrical cardiometry for at least 72 hours after birth. Associations between maternal and neonatal hemodynamic parameters were explored using correlation analysis and generalized linear mixed-effects models (GLMM) accounted for repeated neonatal measurements, neonatal exposure to dopamine or dobutamine and patent ductus arteriosus (PDA). Maternal systolic function indices (cardiac output (CO), Ejection fraction (EF), and ventricle tissue doppler s' velocities) inversely correlated with neonatal CO in fully adjusted GLMM models. EF was positively associated with neonatal systemic vascular resistances (SVR) when adjusted for inotropic support (p = 0.010), with attenuation after additional adjustment for PDA (p = 0.052). Overall, maternal systolic impairment in EOPE was associated with higher neonatal CO, indicating a compensatory increase in neonatal cardiac performance, while changes in neonatal vascular tone were minimal. These findings provide the first quantitative evidence of maternal-neonatal hemodynamic coupling and support the value of integrated cardiovascular assessment of both mother and newborn in hypertensive pregnancies.