Abstract
Pregnancy-induced hypertension (PIH) is common and may affect maternal and children’s healthcare. However, the neurobiological status of neonates born from mothers with PIH has yet to be elucidated. The present study employed physiological imaging to investigate the association between maternal PIH and a number of neonatal health parameters, including cerebral metabolism, hemodynamics, and pathophysiological vulnerabilities. Following the acquisition of ethical approval, we recruited 16 neonates with maternal PIH and 22 normal neonates (non-PIH) as controls. All neonates underwent magnetic resonance imaging (MRI) of the brain. Phase-contrast (PC) MRI and T2-relaxation-under-spin-tagging (TRUST) MRI were performed to determine global cerebral blood flow, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2). These physiological parameters were then compared between PIH neonates and controls. Linear regression analysis was performed to investigate the associations between maternal PIH and each of the physiological parameters. Receiver operating characteristic curves (ROCs) were used to determine whether maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) which could facilitate the diagnosis of neonatal brain injuries. PIH neonates showed significantly lower OEF (25.5 ± 8.8% vs. 32.6 ± 7.3%, P = 0.01) and CMRO2 (29.7 ± 9.4 vs. 40.9 ± 15.0 μmol/100 g/min, P = 0.01) compared to the controls. Maternal blood pressure levels [PIH or non-PIH groups, each one standard deviation (SD) increase in SBP, DBP, and MAP, respectively] were negatively associated with OEF [regression coefficient (β) = −7.9, P = 0.007; β = −4.2, P = 0.004; β = −3.6, P = 0.02; β = −4.0, P = 0.008, respectively). Furthermore, each one SD increase in maternal DBP and MAP was negatively associated with CMRO2 (β = −4.7, P = 0.03; β = −4.4, P = 0.04, respectively). The areas under the curves (AUCs) with 95% confidence intervals (CIs) for maternal SBP, DBP, and MAP were 0.90 (0.80–0.97), 0.85 (0.73–0.97), and 0.89 (0.76–0.99), respectively. The AUC values for maternal SBP, DBP, and MAP indicated good diagnostic ability for identifying neonatal brain injuries. The present study demonstrated that maternal PIH may be associated with a lower oxygen extraction and lower cerebral metabolism in neonates.
Highlights
Pregnancy-induced hypertension (PIH) is a substantial global public health issue for maternal and children’s healthcare (Visintin et al, 2010)
Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) are recognized as important physiological indices. These variables are usually measured via computed tomography (CT) (Zebedin et al, 2013), positron emission tomography (PET) imaging (Luo et al, 2014), nearinfrared spectroscopy (NIRS) (Kusaka et al, 2014; Goeral et al, 2017), or 133xenon clearance (Colditz et al, 1988)
The scoring system for the composite white matter and gray matter scores consisted of white matter/gray matter signal abnormality, loss in the volume of periventricular white matter, FIGURE 1 | Framework showing how cerebral metabolic rate of oxygen (CMRO2) was measured. (A) Step 1: a time-of-flight (TOF) MR angiogram (MRA) was performed to position the major feeding arteries of the brain, the left and right internal carotid arteries (LICA and RICA) and the left and right vertebral arteries (LVA and RVA). (B) Step 2: slice positions of the PC magnetic resonance imaging (MRI) scans were overlayed on an angiogram image
Summary
Pregnancy-induced hypertension (PIH) is a substantial global public health issue for maternal and children’s healthcare (Visintin et al, 2010). PIH complicates approximately 6–10% of all pregnancies globally (Kintiraki et al, 2015) It is one of the trigger factors for maternal posterior reversible encephalopathy syndrome (PRES) and iatrogenic premature birth. Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) are recognized as important physiological indices. These variables are usually measured via computed tomography (CT) (Zebedin et al, 2013), positron emission tomography (PET) imaging (Luo et al, 2014), nearinfrared spectroscopy (NIRS) (Kusaka et al, 2014; Goeral et al, 2017), or 133xenon clearance (Colditz et al, 1988). Few neurobiological studies have been conducted on the effects of maternal PIH on cerebral oxygen metabolism and hemodynamics in neonates
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