Maternal cardiac differences preceded fetal growth restriction and pre-eclampsia in cohort study

This prospective cohort study included 948 singleton pregnancies at high risk for FGR referred to a fetal medicine department in Barcelona. Maternal echocardiography was performed at 27+0 to 28+6 weeks, before FGR or PE had been diagnosed. During follow-up, 59 patients developed FGR, with or without PE, 70 developed isolated PE, and 819 had uncomplicated pregnancies. The assessment included cardiac output (CO), stroke volume, systemic vascular resistance (SVR) and cardiac structural measures.

Both groups that later developed complications had lower median CO and higher SVR than the uncomplicated group. Median SVR was 1,393 dynes × s/cm⁵ in the FGR group and 1,339 in the isolated-PE group, versus 1,252 in uncomplicated pregnancies. Median stroke volume was also lower in both groups. The FGR group had a smaller left ventricular end-diastolic diameter, while isolated PE was associated with thicker left ventricular walls and higher heart rate than FGR.

The results suggest that cardiovascular differences may precede these pregnancy complications and vary by phenotype. However, this observational study does not show that echocardiography improves prediction or outcomes, or establish thresholds for clinical use. The findings alone do not support changing current assessment or management.