Associations of maternal metabolic profile with placental and fetal cerebral and cardiac hemodynamics

Abstract

Maternal obesity and metabolic health affect pregnancy outcomes. We examined whether maternal metabolic profiles are associated with placental and fetal hemodynamics. Study Design: In a population-based prospective cohort study among 1175 women we examined the associations of an adverse maternal metabolic profile in early pregnancy with placental, fetal cerebral and cardiac hemodynamic development. We obtained maternal pre-pregnancy BMI by questionnaire and measured blood pressure, cholesterol, triglycerides and glucose concentrations at a median gestational age of 12.6 (95 % range 9.6-17.1) weeks. An adverse maternal metabolic profile was defined as !4 risk factors. Placental and fetal hemodynamics were measured by pulsed-wave-Doppler at a median gestational age of 30.3 (95 % range 28.8-32.3) weeks. Results: An adverse maternal metabolic profile was associated with a 0.29 Z-score higher (95 %CI 0.08À0.50) fetal cerebral middle artery pulsatility index (PI), but not with placental or fetal cardiac hemodynamic patterns. When the individual components of an adverse maternal metabolic profile were assessed, we observed that higher maternal total cholesterol and triglyceride concentrations were associated with a higher cerebral middle artery PI (Z-score, 0.09 (95 %CI 0.02À0.15), 0.09 (95 %CI 0.03À0.15) per Z-score increase). Higher total and HDL maternal cholesterol concentrations were also associated with a higher aorta ascendens peak systolic velocity (PSV) Z-score, 0.08 (95 %CI 0.01À0.14)), and a larger left cardiac output (Z-score, 0.08 (95 %CI 0.00À0.15), respectively). Conclusion: An adverse maternal metabolic profile, especially higher cholesterol and triglycerides concentrations, are associated with increased fetal cerebral vascular resistance and larger fetal aorta ascendens diameter, PSV and left cardiac output, but not with placental vascular resistance indices. Further studies are needed to identify long-term consequences of the observed associations.

Evaluation of the selected parameters of the fetal diastolic functions in normally grown or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control

“…They reported that no associations of maternal glucose concentrations with third trimester fetal cerebral, placental, and cardiac haemodynamics (mitral valve early and late diastolic filling ratio, ascendant aorta peak systolic velocity and diameter, output) were present. 27 Unlike our study, in a previous study where the fetal cardiac diastolic functions of mothers with diabetes were assessed, Zielinsky et al reported that compared to normal controls, fetuses of diabetic mothers have significantly lower left atrial shortening fraction, higher pulmonary vein pulsatility index, and an impaired left ventricular diastolic function probably as a result of myocardial hypertrophy. In their study, the type of diabetes, whether gestational or pre-gestational, was not mentioned, no subgroup distinction was made regarding fetal characteristics, and the sample size was relatively small (14 fetuses of diabetic mothers and 26 fetuses of normal control mothers).…”

“…Many studies have focused on evaluating values of the fetal cardiac functions in diabetic pregnancies for predicting fetal deterioration. 10,11,[25][26][27][28][29][30] However, these studies have displayed inconsistent results. Although not performed to cover a specific fetal subgroup as our study, the results of the previous two studies were in line with the findings of our study.…”

Impacto da infecção pelo SARS-CoV-2 nos resultados gestacionais e neonatais em gestantes acompanhadas no Hospital das Clínicas da Faculdade de Medicina e no Hospital Universitário da USP

“…Entretanto, essa conclusão precisa ser mais bem investigada, já que o sofrimento fetal é uma complicação obstétrica altamente associada ao quadro metabólico e hemodinâmico materno, sendo uma resposta esperada quando há gravidade da doença, pela consequente priorização de órgãos vitais e redução do fluxo sanguíneo útero-placentário 153,154 .…”