Fetal cardiac function at 35–37 weeks' gestation in pregnancies that subsequently develop pre‐eclampsia

Abstract

Objective To compare fetal cardiac morphology and function between pregnancies that subsequently developed pre‐eclampsia (PE) and those that remained normotensive. Methods This was a prospective observational study in 1574 pregnancies at 35–37 weeks' gestation, including 76 that subsequently developed PE. We carried out comprehensive assessment of fetal cardiac morphology and function including novel imaging modalities, such as speckle‐tracking echocardiography, and measured uterine artery pulsatility index, mean arterial pressure (MAP), serum placental growth factor (PlGF), soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and cerebroplacental ratio (CPR). The findings in the group that subsequently developed PE were compared to those in pregnancies that remained normotensive. Results In fetuses of mothers who subsequently developed PE, compared to those from normotensive pregnancies, there was a more globular right ventricle, as shown by reduced right ventricular sphericity index, reduced right ventricular systolic contractility, as shown by reduced global longitudinal strain, and reduced left ventricular diastolic function, as shown by increased E/A ratio. On multivariable regression analysis, these indices demonstrated an association with PE, independent of maternal characteristics and fetal size. In pregnancies that subsequently developed PE, compared to those that remained normotensive, MAP, sFlt‐1 and the incidence of low birth weight were higher, whereas serum PlGF, CPR and the interval between assessment and delivery were lower. These findings demonstrate that, in pregnancies that develop PE, there is evidence of impaired placentation, reflected in low PlGF and reduced birth weight, placental ischemia, evidenced by increased sFlt‐1 which becomes apparent in the interval of 2–4 weeks preceding the clinical onset of PE, and consequent fetal hypoxia‐induced redistribution in the fetal circulation, reflected in the low CPR. Conclusion Although the etiology of the observed fetal cardiac changes in pregnancies that subsequently develop PE remains unclear, it is possible that the reduction in right‐heart systolic function is the consequence of high afterload due to increased placental resistance, whilst the early left ventricular diastolic changes could be due to fetal hypoxia‐induced redistribution in the fetal circulation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

Fetal myocardial deformation measured with two‐dimensional speckle‐tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses

“…From inclusion until delivery, fetal heart ultrasound scans were performed to obtain 2D four-chamber clips every 4 weeks with a 1-week difference margin. Women who developed gestational diabetes or hypertensive disease and those who delivered a neonate with birth weight < 10 th percentile (corrected for gender and GA at birth) or with congenital or genetic abnormality were excluded from the analysis, as these factors may influence myocardial deformation values 4,12,[22][23][24] .…”

Novel Speckle Tracking Analysis Showed Excellent Reproducibility for Size and Shape of the Fetal Heart and Good Reproducibility for Strain and Fractional Shortening

“…Two-dimensional speckle tracking (2DST) analysis has been used in pediatric and adult cardiology to assess motion during the cardiac cycle, thus yielding important information about segmental and global function of the heart [1][2][3][4]. It has also been proposed as a method to evaluate changes in fetal cardiac contractility in normal fetuses [5][6][7][8][9] and in the presence of maternal and/or fetal complications, and in fetuses with congenital heart anomalies [10][11][12][13][14][15][16][17][18]. However, physiologic and technical aspects such as small size of the heart, fetal heart rate, fetal motion, gestational age, and anatomical plane for image acquisition, have limited the systematic use of this technology in the fetal domain [9,19].…”

Fetal Cardiac Function at Midgestation in Women Who Subsequently Develop Gestational Diabetes

“…These terms were prespecified on the basis of exploratory analysis and previous publication. 18,19 Histograms were used to identify suitable transformations where appropriate and backward elimination was used for model selection.…”