Does pre-eclampsia influence fetal cardiovascular function in early-onset intrauterine growth restriction?
OBJECTIVE
Increasing evidence shows that intrauterine growth restriction (IUGR) is associated with fetal cardiac dysfunction. Most studies group IUGR with and without pre-eclampsia (PE) altogether. Our objective was to evaluate whether the association with PE has any impact on cardiac function in IUGR fetuses


METHODS
Thirty-one normotensive IUGR cases and 31 IUGR cases with pre-eclampsia (PE + IUGR) below 34 weeks of gestation were included. IUGR was defined as a birth weight below the 10(th) centile together with an umbilical artery pulsatility index above 2 SD. Fetal cardiac function was assessed by measuring ductus venosus pulsatility index, modified myocardial performance index, aortic isthmus blood flow, E/A ratios and cardiac output. The presence of fetal cardiac dysfunction was also assessed by measuring cord blood B-type natriuretic peptide (BNP) levels collected at birth. Echocardiographic data were compared with those in 80 term appropriate-for-gestational age (AGA) fetuses from normotensive mothers. Cord blood BNP levels were compared with those in 40 AGA cases that delivered preterm.


RESULTS
All IUGR cases (with or without PE) showed echocardiographic and biochemical signs of cardiac dysfunction compared with AGA cases. However, no differences were observed between IUGR and PE + IUGR cases either in echocardiographic or in biochemical parameters. IUGR cases with or without PE had similar perinatal results.


CONCLUSIONS
IUGR fetuses showed echocardiographic and biochemical signs of cardiac dysfunction. Pre-eclampsia per se does not influence cardiac function in IUGR fetuses.
Crispi
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Maternal-Fetal Medicine Department, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Hospital Clinic, Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
Comas
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Hernández-Andrade
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Eixarch
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Gómez
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Figueras
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Gratacós
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D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005865:Gestational Age; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011225:Pre-Eclampsia / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011673:Pulsatile Flow / Q000502:physiology*; D018570:Risk Assessment; D016216:Ultrasonography, Prenatal
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain