Ophthalmic artery Doppler at 35–37 weeks' gestation in pregnancies with small or growth‐restricted fetuses

Abstract

Objectives First, to compare the ophthalmic artery peak systolic velocity (PSV) ratio at 35–37 weeks' gestation among women who delivered small‐for‐gestational‐age (SGA) or growth‐restricted (FGR) neonates in the absence of hypertensive disorders, women who developed pre‐eclampsia (PE) or gestational hypertension (GH) and those without SGA, FGR, PE or GH. Second, to examine the association of PSV ratio with placental growth factor (PlGF) and mean arterial pressure (MAP). Third, to assess the associations of PSV ratio, PlGF and MAP with birth‐weight Z‐score and percentile. Methods This was a prospective observational study in women attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination of fetal anatomy and growth, and measurement of maternal ophthalmic artery PSV ratio, first (PSV1) and second (PSV2) peaks of systolic velocity, MAP and serum PlGF. The values of PSV ratio, MAP and PlGF were converted to multiples of the median (MoM) or delta values, and the median MoM or delta of these variables in the SGA, FGR, PE and GH groups were compared with those in the unaffected group. Regression analysis was used to examine the relationship of PSV ratio delta, PlGF MoM and MAP MoM with birth‐weight Z‐score after exclusion of PE and GH cases. Regression analysis was also used to examine the association of PSV ratio delta with log10 PlGF MoM and log10 MAP MoM. Results The study population included 2287 pregnancies, of which 1954 (85.4%) were not affected by FGR, SGA, PE or GH, 49 (2.1%) were complicated by FGR in the absence of PE or GH, 160 (7.0%) had SGA in the absence of FGR, PE or GH, 60 (2.6%) had PE and 64 (2.8%) had GH. Compared with unaffected pregnancies, in both the FGR and SGA groups, the means of PSV ratio delta (0.042 (95% CI, 0.007–0.076) and 0.032 (95% CI, 0.016–0.049), respectively) and MAP MoM (1.028 (95% CI, 1.006–1.050) and 1.048 (95% CI, 1.035–1.060), respectively) were increased, while the mean of PlGF MoM was decreased (0.495 (95% CI, 0.393–0.622) and 0.648 (95% CI, 0.562–0.747), respectively). However, the magnitude of these changes was smaller than in the PE and GH groups. Ophthalmic artery waveform analysis revealed that the predominant feature of pregnancies complicated by SGA in the absence of hypertensive disorders was a reduction in PSV1, whereas, in those with hypertensive disorders, there was an increase in PSV2. In non‐hypertensive pregnancies, there were linear inverse associations of PSV ratio delta and MAP MoM with birth‐weight Z‐score, with increased values in small neonates and decreased values in large neonates. There was a quadratic relationship between PlGF MoM and birth‐weight Z‐score, with low PlGF levels in small neonates and high PlGF levels in large neonates. There was a significant correlation of ophthalmic artery PSV ratio delta with both log10 MAP MoM (0.124 (95% CI, 0.069–0.178)) and log10 PlGF MoM (−0.238 (95% CI, −0.289 to −0.185))...

Ophthalmic artery Doppler at 19–23 weeks' gestation in pregnancies that deliver small‐for‐gestational‐age neonates

“…In addition, subgroup analysis revealed that the magnitude of responses was greater in preterm pregnancies although results did not reach statistical significance levels, possibly due to the smaller number of observations. In a previous study in the third trimester, we reported that, in both pregnancies complicated by hypertensive disorders and those delivering a SGA neonate, the PSV ratio was increased, but waveform analysis revealed that the predominant feature in pregnancies complicated by SGA is reduction in PSV1 wave, whereas, in hypertensive disorders, there is an increase in PSV2 wave 13 . This finding demonstrates differences in maternal adaptation during gestation.…”

“…However, waveform analysis revealed that the predominant feature in pregnancies complicated by SGA was reduction in PSV1, whereas, in hypertensive disorders, there was an increase in PSV2. These findings suggest that the predominant feature of SGA is reduced cardiac output, whereas the main feature of PE is increased peripheral vascular resistance 13 .…”

“…Pregnancies complicated by small‐for‐gestational age (SGA) at birth in the absence of hypertensive disorders share features with pregnancies complicated by PE, including impaired placentation and endothelial dysfunction, and women with these pregnancy complications are at increased risk of long‐term development of cardiovascular disease 7–12 . In a recent study of 2287 singleton pregnancies at 35–37 weeks' gestation, we found that, in women delivering a SGA neonate in the absence of hypertensive disorders, similar to those that develop PE, the ophthalmic artery PSV ratio and mean arterial pressure (MAP) were increased and serum placental growth factor (PlGF) was decreased, but the magnitude of these changes was greater in the PE than in the SGA group 13 . However, waveform analysis revealed that the predominant feature in pregnancies complicated by SGA was reduction in PSV1, whereas, in hypertensive disorders, there was an increase in PSV2.…”

Ophthalmic artery Doppler and biomarkers of impaired placentation at 36 weeks' gestation in pregnancies with small fetuses

“…Pregnancies complicated by delivery of a small-forgestational-age (SGA) neonate, in the absence of hypertensive disorder, share features with pregnancies complicated by PE, including impaired placentation and endothelial dysfunction, and women with these pregnancy complications are at increased risk of long-term development of cardiovascular disease [8][9][10][11][12][13] . Several studies have reported on ophthalmic artery Doppler in SGA pregnancy [14][15][16][17] . A cross-sectional study of 60 pregnancies with SGA at 32-40 weeks' gestation and 60 normal controls reported that the PSV ratio in the SGA group was significantly higher than that in the control group 14 .…”

“…A prospective observational study of 499 singleton pregnancies at 11-14 weeks' gestation reported that the PSV ratio in the group of 27 women who delivered a SGA neonate was slightly higher than that in the non-SGA group 15 . We have previously performed two observational studies in women with a singleton pregnancy attending for a routine hospital visit: one in 5214 women at 19-23 weeks' gestation and another in 2287 women at 35-37 weeks 16,17 . In these studies, we found that, compared with unaffected pregnancies, pregnant women who subsequently developed a hypertensive disorder and those delivering a SGA neonate had increased ophthalmic artery PSV ratio and reduced serum placental growth factor (PlGF), but the magnitude of these changes in the SGA group was smaller than that in the PE and gestational hypertension (GH) groups.…”