288: Is endothelial function impaired among women with placenta-mediated fetal growth restriction?

Abstract

To assess maternal endothelial function in pregnancies complicated by IUGR due to placental dysfunction. Prospective study assessing endothelial function using EndoPAT device in 2 populations of pregnant patients: 1. women with estimated fetal weight (EFW) below 10th percentile and abnormal uterine arteries and/or umbilical artery flow (n=15); and 2. Women with AGA fetus without placental complications matched by gestational age at testing (control group, n=22). Exclusion criteria included multifetal gestation, hypertensive diseases, diabetes mellitus, renal disease, smoking and pregnancies complicated by fetal anomalies or genetic abnormalities. EndoPAT evaluates the change in peripheral vascular tone in reaction to temporal ischemia in a process called reactive hyperemia. The ratio of the readings before and after ischemia is used to calculate the score for endothelial function and called reactive hyperemia index (RHI). Abnormal RHI indicating endothelial dysfunction is defined as RHI ≤ 1.67 in the non-pregnant population. Demographic and clinical characteristics did not differ between the two groups. The mean gestational age at endoPAT examination was comparable between the IUGR and control group (32.5 ± 2.2 vs, 31.6 ± 3.2, p=0.21). The 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 as well as neonatal birth weight were lower in the FGR 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). Pregnant women with fetal growth restriction due to placental dysfunction are characterized by endothelial dysfunction. Further studies are required in order to determine whether endothelial dysfunction is the cause or the consequence of placental dysfunction. Furthermore, delivery of IUGR has been associated with the development of cardiovascular condition later in life. Thus, the results of the present study may provide a putative explanation for this association.