Maternal cardiac function in normotensive and pre-eclamptic intrauterine growth restriction.

Abstract

To compare maternal cardiac function between pregnancies complicated by normotensive and pre-eclamptic intrauterine growth restriction (IUGR). Two-dimensional Doppler echocardiography and Doppler tissue imaging (DTI) were used to examine 19 pregnant women with IUGR and 17 with pre-eclampsia complicated by IUGR at 20-38 weeks of gestation. Indices were converted into differences in SDs from the expected normal mean for gestation (Z-scores) and compared. With respect to normal pregnancy, in the normotensive IUGR compared with the pre-eclamptic IUGR group, there were similar reductions in maternal cardiac output (Z-score, - 1.71 vs. - 1.37, P = 0.26) and heart rate (Z-score, - 3.67 vs. - 9.43, P = 0.1) and a similar increase in total vascular resistance (Z-score, 2.91 vs. 3.93, P = 0.05). There was also a greater decrease in stroke volume (Z-score, - 1.72 vs. - 0.69, P = 0.01), a smaller increase in mean arterial pressure (Z-score, 0.73 vs. 2.94, P < 0.01) and a smaller decrease in DTI systolic velocity at the lateral mitral margin (Z-score, - 0.4 vs. - 1.42, P = 0.02). In terms of diastolic function, there was a smaller transmitral late diastolic velocity (Z-score, 0.04 vs. 0.93, P = 0.03) and a greater DTI early diastolic velocity at the lateral mitral margin (Z-score, - 0.17 vs. - 1.6, P < 0.01). In normotensive IUGR and pre-eclamptic IUGR there is a similar alteration in maternal left ventricular systolic function, but there is greater impairment in maternal diastolic function in pre-eclamptic IUGR.