Is endothelial function impaired among women with placenta-mediated
fetal growth restriction? Evidence from a prospective cohort study using
peripheral artery tonometry
Abstract
Objective- To assess maternal endothelial function in singleton
pregnancies complicated by intrauterine growth restriction (IUGR) due to
placental dysfunction. Design- Prospective cohort study. Setting- 37
pregnant women who underwent endothelial function assessment using
EndoPATTM device. Population or Sample- Study population included two
groups: 1. Pregnancies with estimated fetal weight below 10th percentile
and abnormal umbilical artery flow (n=15); 2. Pregnancies with normal
fetal growth without placental complications matched by gestational age
(n=22). Exclusion criteria included diseases with potential vascular
dysfunction or smoking. Methods- EndoPAT device evaluates changes in
peripheral vascular flow and tone in reaction to temporal ischemia.
Normal post-ischemic endothelial reaction is an increase in vascular
flow. A ratio of the readings before and after ischemia is used to
calculate the score for endothelial function, called reactive hyperemic
index (RHI). Low RHI value indicates endothelial dysfunction. Main
outcome measures- RHI values. Results- Mean gestational age at endoPAT
examination was comparable between the IUGR and control group (32.5 ±
2.2 vs, 31.6 ± 3.2, respectively; p=0.21). Mean RHI was significantly
lower in the IUGR group compared to the control group (1.32 ± 0.16 vs
1.51 ± 0.31, p= 0.02, respectively). As expected, mean gestational age
at delivery and neonatal birth weight were lower in the IUGR group
compared to the control group (35.4 ± 2.3 vs 37.3 ± 2.6 p=0.04; 1640 ±
414 grams vs 2785 ± 587 grams, p<0.001 respectively).
Conclusions- Pregnant women with isolated IUGR due to placental
dysfunction had impaired endothelial function.