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Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation

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Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation. / Garcia-Gonzalez, Coral; Abdel-Azim, Samira; Galeva, Slavyana; Georgiopoulos, Georgios; Nicolaides, Kypros H.; Charakida, Marietta.

In: American Journal of Obstetrics and Gynecology, Vol. 222, No. 6, 06.2020, p. 604.e1-604.e10.

Research output: Contribution to journalArticle

Harvard

Garcia-Gonzalez, C, Abdel-Azim, S, Galeva, S, Georgiopoulos, G, Nicolaides, KH & Charakida, M 2020, 'Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation', American Journal of Obstetrics and Gynecology, vol. 222, no. 6, pp. 604.e1-604.e10. https://doi.org/10.1016/j.ajog.2020.01.011

APA

Garcia-Gonzalez, C., Abdel-Azim, S., Galeva, S., Georgiopoulos, G., Nicolaides, K. H., & Charakida, M. (2020). Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation. American Journal of Obstetrics and Gynecology, 222(6), 604.e1-604.e10. https://doi.org/10.1016/j.ajog.2020.01.011

Vancouver

Garcia-Gonzalez C, Abdel-Azim S, Galeva S, Georgiopoulos G, Nicolaides KH, Charakida M. Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation. American Journal of Obstetrics and Gynecology. 2020 Jun;222(6):604.e1-604.e10. https://doi.org/10.1016/j.ajog.2020.01.011

Author

Garcia-Gonzalez, Coral ; Abdel-Azim, Samira ; Galeva, Slavyana ; Georgiopoulos, Georgios ; Nicolaides, Kypros H. ; Charakida, Marietta. / Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation. In: American Journal of Obstetrics and Gynecology. 2020 ; Vol. 222, No. 6. pp. 604.e1-604.e10.

Bibtex Download

@article{e67728c11b224ef8897edd1512bb7e42,
title = "Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation",
abstract = "Background: Over the years, there has been an increasing interest in the assessment of maternal hemodynamic responses during pregnancy. With the use of both noninvasive devices and/or maternal echocardiography, it has been shown that mothers who have pregnancy complications have altered hemodynamics compared with those who have uncomplicated pregnancies. It also has been suggested that preexisting maternal cardiac changes might drive the development of complications in pregnancy that are associated with impaired placentation. To understand, however, this potential link in complicated pregnancies, it is important to clarify whether placental function is associated with maternal cardiac functional indices in normal pregnancies. Objective: To determine whether placental function, perfusion, and fetal weight are associated with maternal cardiac hemodynamic responses at 35–36 weeks of gestation in normal pregnancies. Study Design: Prospective screening of women attending Kings’ College Hospital for routine hospital visit at 35–37 weeks’ gestation. We recorded maternal characteristics and measured mean arterial pressure, uterine artery pulsatility index, sonographic estimated fetal weight, and serum placental growth factor and soluble fms-like tyrosine kinase 1. We also performed maternal echocardiogram to assess cardiac output and peripheral vascular resistance as well as indices of diastolic and systolic function, including global longitudinal systolic function and left ventricular mass indexed to body surface area. Results: We studied 1386 women. Maternal characteristics were associated with both maternal hemodynamics and functional and structural indices. Uterine artery pulsatility index was associated with left ventricular mass (P=.03) and global longitudinal systolic function (P=.017). There were significant nonlinear associations between placental growth factor and cardiac output and peripheral vascular resistance (P<.001 for both) and between soluble fms-like tyrosine kinase 1 and peripheral vascular resistance (P=.018). Estimated fetal weight was associated with maternal cardiac output (mean increase=0.186, 95{\%} confidence interval, 0.133–0.238, P<.001) and peripheral vascular resistance (mean decrease=–0.164, 95{\%} confidence interval, –0.217 to –0.111, P<.001). No association was noted between placental and fetal parameters and maternal cardiac functional and structural indices. In multivariable analysis, placental growth factor remained strongly associated with maternal cardiac output and peripheral vascular resistance (P=.002 for both) over and above maternal characteristics and estimated fetal weight. Estimated fetal weight was associated with left ventricular mass (0.102, 95{\%} confidence interval, 0.044–0.162, P=.001). Conclusion: The results of this study suggest a strong link between maternal hemodynamic responses and fetoplacental needs across the whole spectrum in normal pregnancies. These findings would also indicate that to diagnose maternal cardiac dysfunction in pregnancies complicated by impaired placentation a more extensive echocardiographic assessment might be needed rather than relying on hemodynamics which are strongly associated with fetoplacental indices.",
keywords = "biomarkers, cardiac output, maternal hemodynamics, mean arterial pressure, peripheral resistance, placental growth factor, pregnancy, soluble fms-like tyrosine kinase-1, uterine artery Doppler",
author = "Coral Garcia-Gonzalez and Samira Abdel-Azim and Slavyana Galeva and Georgios Georgiopoulos and Nicolaides, {Kypros H.} and Marietta Charakida",
year = "2020",
month = "6",
doi = "10.1016/j.ajog.2020.01.011",
language = "English",
volume = "222",
pages = "604.e1--604.e10",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "6",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation

AU - Garcia-Gonzalez, Coral

AU - Abdel-Azim, Samira

AU - Galeva, Slavyana

AU - Georgiopoulos, Georgios

AU - Nicolaides, Kypros H.

AU - Charakida, Marietta

PY - 2020/6

Y1 - 2020/6

N2 - Background: Over the years, there has been an increasing interest in the assessment of maternal hemodynamic responses during pregnancy. With the use of both noninvasive devices and/or maternal echocardiography, it has been shown that mothers who have pregnancy complications have altered hemodynamics compared with those who have uncomplicated pregnancies. It also has been suggested that preexisting maternal cardiac changes might drive the development of complications in pregnancy that are associated with impaired placentation. To understand, however, this potential link in complicated pregnancies, it is important to clarify whether placental function is associated with maternal cardiac functional indices in normal pregnancies. Objective: To determine whether placental function, perfusion, and fetal weight are associated with maternal cardiac hemodynamic responses at 35–36 weeks of gestation in normal pregnancies. Study Design: Prospective screening of women attending Kings’ College Hospital for routine hospital visit at 35–37 weeks’ gestation. We recorded maternal characteristics and measured mean arterial pressure, uterine artery pulsatility index, sonographic estimated fetal weight, and serum placental growth factor and soluble fms-like tyrosine kinase 1. We also performed maternal echocardiogram to assess cardiac output and peripheral vascular resistance as well as indices of diastolic and systolic function, including global longitudinal systolic function and left ventricular mass indexed to body surface area. Results: We studied 1386 women. Maternal characteristics were associated with both maternal hemodynamics and functional and structural indices. Uterine artery pulsatility index was associated with left ventricular mass (P=.03) and global longitudinal systolic function (P=.017). There were significant nonlinear associations between placental growth factor and cardiac output and peripheral vascular resistance (P<.001 for both) and between soluble fms-like tyrosine kinase 1 and peripheral vascular resistance (P=.018). Estimated fetal weight was associated with maternal cardiac output (mean increase=0.186, 95% confidence interval, 0.133–0.238, P<.001) and peripheral vascular resistance (mean decrease=–0.164, 95% confidence interval, –0.217 to –0.111, P<.001). No association was noted between placental and fetal parameters and maternal cardiac functional and structural indices. In multivariable analysis, placental growth factor remained strongly associated with maternal cardiac output and peripheral vascular resistance (P=.002 for both) over and above maternal characteristics and estimated fetal weight. Estimated fetal weight was associated with left ventricular mass (0.102, 95% confidence interval, 0.044–0.162, P=.001). Conclusion: The results of this study suggest a strong link between maternal hemodynamic responses and fetoplacental needs across the whole spectrum in normal pregnancies. These findings would also indicate that to diagnose maternal cardiac dysfunction in pregnancies complicated by impaired placentation a more extensive echocardiographic assessment might be needed rather than relying on hemodynamics which are strongly associated with fetoplacental indices.

AB - Background: Over the years, there has been an increasing interest in the assessment of maternal hemodynamic responses during pregnancy. With the use of both noninvasive devices and/or maternal echocardiography, it has been shown that mothers who have pregnancy complications have altered hemodynamics compared with those who have uncomplicated pregnancies. It also has been suggested that preexisting maternal cardiac changes might drive the development of complications in pregnancy that are associated with impaired placentation. To understand, however, this potential link in complicated pregnancies, it is important to clarify whether placental function is associated with maternal cardiac functional indices in normal pregnancies. Objective: To determine whether placental function, perfusion, and fetal weight are associated with maternal cardiac hemodynamic responses at 35–36 weeks of gestation in normal pregnancies. Study Design: Prospective screening of women attending Kings’ College Hospital for routine hospital visit at 35–37 weeks’ gestation. We recorded maternal characteristics and measured mean arterial pressure, uterine artery pulsatility index, sonographic estimated fetal weight, and serum placental growth factor and soluble fms-like tyrosine kinase 1. We also performed maternal echocardiogram to assess cardiac output and peripheral vascular resistance as well as indices of diastolic and systolic function, including global longitudinal systolic function and left ventricular mass indexed to body surface area. Results: We studied 1386 women. Maternal characteristics were associated with both maternal hemodynamics and functional and structural indices. Uterine artery pulsatility index was associated with left ventricular mass (P=.03) and global longitudinal systolic function (P=.017). There were significant nonlinear associations between placental growth factor and cardiac output and peripheral vascular resistance (P<.001 for both) and between soluble fms-like tyrosine kinase 1 and peripheral vascular resistance (P=.018). Estimated fetal weight was associated with maternal cardiac output (mean increase=0.186, 95% confidence interval, 0.133–0.238, P<.001) and peripheral vascular resistance (mean decrease=–0.164, 95% confidence interval, –0.217 to –0.111, P<.001). No association was noted between placental and fetal parameters and maternal cardiac functional and structural indices. In multivariable analysis, placental growth factor remained strongly associated with maternal cardiac output and peripheral vascular resistance (P=.002 for both) over and above maternal characteristics and estimated fetal weight. Estimated fetal weight was associated with left ventricular mass (0.102, 95% confidence interval, 0.044–0.162, P=.001). Conclusion: The results of this study suggest a strong link between maternal hemodynamic responses and fetoplacental needs across the whole spectrum in normal pregnancies. These findings would also indicate that to diagnose maternal cardiac dysfunction in pregnancies complicated by impaired placentation a more extensive echocardiographic assessment might be needed rather than relying on hemodynamics which are strongly associated with fetoplacental indices.

KW - biomarkers

KW - cardiac output

KW - maternal hemodynamics

KW - mean arterial pressure

KW - peripheral resistance

KW - placental growth factor

KW - pregnancy

KW - soluble fms-like tyrosine kinase-1

KW - uterine artery Doppler

UR - http://www.scopus.com/inward/record.url?scp=85081616986&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2020.01.011

DO - 10.1016/j.ajog.2020.01.011

M3 - Article

C2 - 31954157

AN - SCOPUS:85081616986

VL - 222

SP - 604.e1-604.e10

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 6

ER -

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