Maternal Low Volume Circulation Relates to Normotensive and Preeclamptic Fetal Growth Restriction

Frontiers in Medicine

article

Wilfried Gyselaers¹  Christoph Lees³ 

[1] Department of Obstetrics;Department of Physiology, Hasselt University;Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust;Department of Metabolism, Digestion and Reproduction, Institute for Reproductive and Developmental Biology, Imperial College London;Department of Development and Regeneration;Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital

关键词: maternal hemodynamic changes in pregnancy;    fetal growth;    intravascular volume;    cardiac output;    venous hemodynamics;    vascular resistance;    body water volume;   

DOI  :  10.3389/fmed.2022.902634

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

This narrative review summarizes current evidence on the association between maternal low volume circulation and poor fetal growth. Though much work has been devoted to the study of cardiac output and peripheral vascular resistance, a low intravascular volume may explain why high vascular resistance causes hypertension in women with preeclampsia (PE) that is associated with fetal growth restriction (FGR) and, at the same time, presents with normotension in FGR itself. Normotensive women with small for gestational age babies show normal gestational blood volume expansion superimposed upon a constitutionally low intravascular volume. Early onset preeclampsia (EPE; occurring before 32 weeks) is commonly associated with FGR, and poor plasma volume expandability may already be present before conception, thus preceding gestational volume expansion. Experimentally induced low plasma volume in rodents predisposes to poor fetal growth and interventions that enhance plasma volume expansion in FGR have shown beneficial effects on intrauterine fetal condition, prolongation of gestation and birth weight. This review makes the case for elevating the maternal intravascular volume with physical exercise with or without Nitric Oxide Donors in FGR and EPE, and evaluating its role as a potential target for prevention and/or management of these conditions.

【 授权许可】

CC BY