Maternal cardiac function in fetal growth-restricted and non-growth-restricted small-for-gestational age pregnancies.

Abstract

To compare maternal cardiac function in women with intrauterine growth restriction (IUGR) to those with small-for-gestational age (SGA) pregnancies (non-IUGR). This was a cross-sectional study involving maternal echocardiography and uterine, umbilical and fetal middle cerebral artery Doppler assessment in 52 normotensive women at 20-36 weeks' gestation with SGA fetuses (26 IUGR and 26 non-IUGR). In the IUGR (compared to the non-IUGR) group, maternal cardiac output (CO) was lower (4.7 vs. 6.1 L/min, P<0.001) and total vascular resistance (TVR) was higher (1444 vs. 1088 dynes/s/cm5, P<0.001). The lower CO was due to a lower preload, demonstrated by a reduced stroke volume (59.9 vs. 73.6 mL, P<0.01) and smaller left atrial diameter (LAD) (31.5 vs. 34.1 mm, P=0.01). Mean arterial pressure and diastolic function were similar between the groups. Logistic regression and receiver-operating characteristics curve analysis for detection of IUGR demonstrated that a model using TVR, LAD, fetal middle cerebral artery pulsatility index and gestational age, had a sensitivity of 96.2% and a specificity of 84.6%. Maternal echocardiography can provide a very sensitive tool for identifying IUGR pregnancies.