Multivariable evaluation of the maternal hemodynamic profile in pregnancies complicated by intrauterine growth restriction : a prospective study

BACKGROUND: The aim of this study was to evaluate the effect of intrauterine growth restriction on maternal hemodynamic parameters using a multivariable analysis, adjusting for major confounding factors, such as hypertensive disorders of pregnancy (preeclampsia and gestational hypertension). METHODS: A prospective cohort study was conducted between January 2013 and April 2016. Two cohorts of patients were recruited, between 24 and 39 weeks of gestation in high risk outpatient setting. These cohorts were composed of 49 appropriate for gestational age fetuses and 93 intrauterine growth restricted fetuses (abdominal circumference at recruitment ≤ 10th percentile). Maternal echocardiography was performed at the time of enrollment and included hemodynamic parameters of systolic-diastolic function and cardiac remodeling indices. Data were analyzed using a multivariable general linear model. The general linear model coefficients were used to estimate the effect of intrauterine growth restriction after adjusting for significant confounding factors of hemodynamic parameters. RESULTS: In multivariable analysis, after adjustment for hypertension and smoking, intrauterine growth restriction resulted in a 10% about increase in total vascular resistance and a 10% about reduction in heart rate, cardiac output and left ventricular mass; the same results were confirmed also for indexed parameters. The effect of hypertensive disorders of pregnancy alone produced a 30% about increase in total vascular resistance and 12% about increase in left ventricular mass and 13% reduction in diastolic function; the same results were confirmed also for indexed parameters. CONCLUSIONS: In pregnancies complicated by intrauterine growth restriction and hypertensive disorders, intrauterine growth restriction has a significant independent effect on most maternal hemodynamic parameters, even after adjustment for major cardiovascular confounding factors.