Cardiac output in pre-eclampsia is linked to foetal growth restriction

Takeaway

• Pregnant women with pre-eclampsia (PE) and/or foetal growth restriction (FGR) have distinctly different or even opposing cardiovascular characteristics with no association to gestational age at onset.
• Compared with healthy pregnancies, those with only PE have higher cardiac output (CO) and lower peripheral vascular resistance (PVR) whereas those with FGR only have higher PVR.
• Co-existence of PE and PVR leads to a cardiovascular phenotype resulting in higher PVR and lower CO vs FGR only.

Why this matters

• Existing guidelines for management of hypertension during pregnancy focus only on BP targets without distinguishing between PE and FGR.
• Targeted therapies according to cardiovascular phenotypes would be more helpful.

Study design

• This prospective cohort study compared 45 pathological pregnancies (only PE, 14; FGR only, 16; both PE and FGR, 15) with 107 healthy pregnancies.
• Funding: None disclosed.

Key results

• Women with PE vs healthy pregnancy had higher CO Z scores (1.87±1.35; P=.0001) and a lower PVR Z scores (−0.76±0.89; P=.025).
• Women with only FGR had significantly higher PVR Z scores (0.57±1.18; P=.04), whereas those with both PE and FGR had lower CO Z scores (−0.80±1.3; P=.007) and higher PVR Z scores (2.16±1.96; P=.0001).
• Augmentation index and pulse wave velocity were higher in all women affected by PE and/or FGR.
• In women with PE, CO was positively associated with Z score birth weight (r, 0.42; P=.03).
• No such association was observed in women with FGR only (P=.31). 


Limitations

• Time consuming examinations limited number of participants.