S Verlohren1, K Melchiorre, A Khalil, B Thilaganathan. 1. Department of Obstetrics, Charité University Medicine Berlin, Berlin, Germany; Fetal Medicine Unit, St George's Hospital NHS Healthcare Trust, London, UK.
Abstract
OBJECTIVE: To investigate the relationship between uterine artery Doppler ultrasound indices and birth weight in women with early-, intermediate- and late-onset pre-eclampsia as compared with women with uneventful pregnancy outcome. METHODS: In a retrospective, observational cohort study, uterine artery Doppler assessment was carried out at 18+0 to 23+6 weeks' gestation in 26,893 women attending for routine antenatal care in a tertiary care center. The mean resistance index (RI) and its relationship to the outcome of pregnancy and birth-weight centiles were evaluated. RESULTS: Uterine artery RI showed a significant, negative correlation with birth weight (r= -0.20, P<0.0001). Patients with early-onset pre-eclampsia had an increased prevalence of high uterine artery mean RI, above the 90(th) centile, corresponding to an increased proportion of small-for-gestational age (SGA) neonates with a birth weight below the 10(th) centile. In late-onset pre-eclampsia, however, there was an unexpectedly higher proportion of large-for-gestational-age (LGA) neonates with a birth weight above the 90(th) centile without a concurrent increase in the prevalence of low uterine artery mean RI below the 10(th) centile. CONCLUSIONS: The finding of a bimodal skewed distribution of birth weight, with neonates exhibiting a higher prevalence of both LGA and SGA with late-onset pre-eclampsia, indicates that there are two types of late-onset pre-eclampsia. These findings explain the poor performance of mid-trimester uterine artery Doppler in predicting pre-eclampsia at term and provide insights into the placental origins of the early and late forms of pre-eclampsia.
OBJECTIVE: To investigate the relationship between uterine artery Doppler ultrasound indices and birth weight in women with early-, intermediate- and late-onset pre-eclampsia as compared with women with uneventful pregnancy outcome. METHODS: In a retrospective, observational cohort study, uterine artery Doppler assessment was carried out at 18+0 to 23+6 weeks' gestation in 26,893 women attending for routine antenatal care in a tertiary care center. The mean resistance index (RI) and its relationship to the outcome of pregnancy and birth-weight centiles were evaluated. RESULTS: Uterine artery RI showed a significant, negative correlation with birth weight (r= -0.20, P<0.0001). Patients with early-onset pre-eclampsia had an increased prevalence of high uterine artery mean RI, above the 90(th) centile, corresponding to an increased proportion of small-for-gestational age (SGA) neonates with a birth weight below the 10(th) centile. In late-onset pre-eclampsia, however, there was an unexpectedly higher proportion of large-for-gestational-age (LGA) neonates with a birth weight above the 90(th) centile without a concurrent increase in the prevalence of low uterine artery mean RI below the 10(th) centile. CONCLUSIONS: The finding of a bimodal skewed distribution of birth weight, with neonates exhibiting a higher prevalence of both LGA and SGA with late-onset pre-eclampsia, indicates that there are two types of late-onset pre-eclampsia. These findings explain the poor performance of mid-trimester uterine artery Doppler in predicting pre-eclampsia at term and provide insights into the placental origins of the early and late forms of pre-eclampsia.
Authors: Matthias C Schabel; Victoria H J Roberts; Karen J Gibbins; Monica Rincon; Jessica E Gaffney; Aaron D Streblow; Adam M Wright; Jamie O Lo; Byung Park; Christopher D Kroenke; Kathryn Szczotka; Nathan R Blue; Jessica M Page; Kathy Harvey; Michael W Varner; Robert M Silver; Antonio E Frias Journal: PLoS One Date: 2022-07-19 Impact factor: 3.752
Authors: Nándor Gábor Than; Máté Posta; Dániel Györffy; László Orosz; Gergő Orosz; Simona W Rossi; Géza Ambrus-Aikelin; András Szilágyi; Sándor Nagy; Petronella Hupuczi; Olga Török; Adi L Tarca; Offer Erez; Zoltán Papp; Roberto Romero Journal: Placenta Date: 2022-03-22 Impact factor: 3.287