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Article

Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes

by
Giulia Masini
1,2,†,
Jasmine Tay
1,3,†,
Carmel M McEniery
4,
Ian B Wilkinson
4,
Herbert Valensise
5,
Grazia M Tiralongo
5,
Daniele Farsetti
5,
Wilfried Gyselaers
6,7,
Sharona Vonck
6,8 and
Christoph C. Lees
1,3,9,10,*
1
Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK
2
Fetal Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
3
Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0HS, UK
4
Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge CB2 0QQ, UK
5
Department of Surgery, Division of Obstetrics and Gynecology, Policlinico Casilino, Tor Vergata, University of Rome, 00169 Rome, Italy
6
Department of Obstetrics and Gynecology, Ziekenhuis Oost Limburg, Schiepse Bos 6, 3600 Genk, Belgium
7
Department of Physiology, Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
8
Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
9
Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
10
Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Du Cane Road, London W12 0HS, UK
*
Author to whom correspondence should be addressed.
†
Joint first authors.
J. Clin. Med. 2020, 9(9), 2891; https://doi.org/10.3390/jcm9092891
Received: 5 June 2020 / Revised: 24 August 2020 / Accepted: 2 September 2020 / Published: 7 September 2020
(This article belongs to the Section Obstetrics & Gynecology)
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Abstract

We investigate the relationship between maternal cardiovascular (CV) function and fetal Doppler changes in healthy pregnancies and those with pre-eclampsia (PE), small for gestational age (SGA) or fetal growth restriction (FGR). This was a three-centre prospective study, where CV assessment was performed using inert gas rebreathing, continuous Doppler or impedance cardiography. Maternal cardiac output (CO) and peripheral vascular resistance (PVR) were analysed in relation to the uterine artery, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI, expressed as z-scores by gestational week) using polynomial regression analyses, and in relation to the presence of absent/reversed end diastolic (ARED) flow in the UA. We included 81 healthy controls, 47 women with PE, 65 with SGA/FGR and 40 with PE + SGA/FGR. Maternal CO was inversely related to fetal UA PI and positively related to MCA PI; the opposite was observed for PVR, which was also positively associated with increased uterine artery impedance. CO was lower (z-score 97, p = 0.02) and PVR higher (z-score 2.88, p = 0.02) with UA ARED flow. We report that maternal CV dysfunction is associated with fetal vascular changes, namely raised impedance in the fetal-placental circulation and low impedance in the fetal cerebral vessels. These findings are most evident with critical UA Doppler changes and represent a potential mechanism for therapeutic intervention. View Full-Text
Keywords: cardiovascular function; cardiac output; Doppler; fetal growth restriction; pre-eclampsia cardiovascular function; cardiac output; Doppler; fetal growth restriction; pre-eclampsia
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MDPI and ACS Style

Masini, G.; Tay, J.; McEniery, C.M.; Wilkinson, I.B.; Valensise, H.; Tiralongo, G.M.; Farsetti, D.; Gyselaers, W.; Vonck, S.; Lees, C.C. Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes. J. Clin. Med. 2020, 9, 2891. https://doi.org/10.3390/jcm9092891

AMA Style

Masini G, Tay J, McEniery CM, Wilkinson IB, Valensise H, Tiralongo GM, Farsetti D, Gyselaers W, Vonck S, Lees CC. Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes. Journal of Clinical Medicine. 2020; 9(9):2891. https://doi.org/10.3390/jcm9092891

Chicago/Turabian Style

Masini, Giulia, Jasmine Tay, Carmel M McEniery, Ian B Wilkinson, Herbert Valensise, Grazia M Tiralongo, Daniele Farsetti, Wilfried Gyselaers, Sharona Vonck, and Christoph C. Lees. 2020. "Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes" Journal of Clinical Medicine 9, no. 9: 2891. https://doi.org/10.3390/jcm9092891

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