Maternal-fetal Circulation,maternal Carotid Artery Stiffness And Serum Concentrations Of Biochemical Markers In Preeclampsia

Objective: Preeclampsia(PE)affects 3% to 8% of pregnant women and remains a major cause of maternal and fetal morbidity and mortality,worldwide.The etiology of PE remains unclear.Its mechanism is widely believed to involve the inadequate invasion of the uterine spiral arteries by trophoblasts,which leads to placental ischemia and release of placental factors that provoke generalized endothelial dysfunction in the mother.Doppler velocimetry is the useful tool to access maternal-fetal circulation and predict pregnancy outcomes.We assessed the effects of PE on maternal and fetal circulations by analyzing the Doppler ultrasound indices of the uterine artery,umbilical artery,fetal middle cerebral artery(MCA),and ductus venosus(DV).Endothelial dysfunction is responsible for the clinical manifestations and plays a central role in the pathological changes of PE.Vascular endothelial injury might be the main cause of increased arterial stiffness in pregnant women with PE.The endogenous imbalance between angiogenic and anti-angiogenic factors,especially low concentrations of placental growth factor(PlGF)and high concentrations of soluble fms-like tyrosine kinase-1(sFlt-1),had been showed to mediate the endothelial dysfunction of PE.Endothelin-1(ET-1)is a vasoconstrictor produced by vascular endothelial cells.When endothelial cells are damaged in PE,the serum concentrations of ET-1 are increased.The purpose of this study is first to access the hemodynamic changes of maternal and fetal circulation in PE,the changes of maternal carotid stiffness and maternal serum concentrations of PlGF,sFlt-1,and ET-1 in PE;second to correlate Doppler indices of maternal-fetal circulation with maternal carotid stiffness and serum concentrations of PlGF,sFlt-1,and ET-1 in PE group;and third to correlate indices of maternal-fetal circulation,maternal carotid stiffness,and serum concentrations of PlGF,sFlt-1,and ET-1 with PE severity and perinatal outcomes in PE group.Methods: A case-control study was conducted on 33 women with PE and 33 normotensive pregnant women between January and September 2014.Doppler indices of the uterine artery,umbilical artery,fetal middle cerebral artery and ductus venosus were measured in both groups.Measurements of the common carotid artery were performed by the Aloka ultrasonic echo-tracking technique.The echo-tracking variables that reflect arterial wall characteristics,that is,pulse wave velocity(PWVβ),augmentation index(AI),stiffness parameter(β),arterial compliance(AC),and pressure-strain elastic modulus(Ep),are automatically calculated by the system.The serum concentrations of PlGF and sFlt-1 were detected by enzyme linked immunosorbent assay in both groups.Results: 1.The PI of the uterine artery and of the umbilical artery was significantly higher in the women with PE than in the healthy controls.The PI of the fetal MCA and CPR was significantly lower in the women with PE than in the healthy controls.There was no significant difference in PIV of DV between PE group and control group.2.In PE group,uterine artery PI was negatively correlated with delivery gestational age,negatively correlated with birth weight,and negatively correlated with 1 min Apgar score.Umbilical artery PI was negatively correlated with birth weight.CPR was positively related with 1 min Apgar score.3.Ep,β,PWVβ,and AI were significantly higher and AC was significantly lower in the women with PE than in the healthy controls.4.In PE group,PWVβ showed a positive correlation with the PI of the uterine artery.The AI of the maternal carotid artery showed positive correlations with the PI of the uterine artery and of the umbilical artery,and negative correlation with the CPR.5.In PE group,AI showed negative correlations with birth weight and Apgar score.6.The serum PlGF of the women with PE was significantly lower than that in the healthy controls,and the sFlt-1 was significantly higher.7.Serum PlGF was negatively correlated with the PI of the uterine artery and serum sFlt-1 was positively correlated with the PI of the uterine artery.8.Serum PlGF was negatively correlated with Ps,Pd,and MAP and positively correlated with gestational age at examination,gestational age at birth and birth weight.Conclusion: 1.Compared with normal pregnancies,uterine artery PI and umbilical artery PI was higher in PE,fetal middle cerebral artery PI and CPR was lower in PE,ductus venosus PIV has no obvious change.2.Elevated uterine artery PI,umbilical artery PI and declined CPR were associated with adverse perinatal outcomes in PE.3.The stiffness of the carotid arteries of women with PE is increased.4.The increase of the carotid arterial stiffness in women with PE is positively correlated with the impedance of the umbilical and uterine arteries.5.Echo-tracking enables the noninvasive evaluation of the carotid arterial stiffness of pregnant women with PE and may help predicting perinatal outcomes.6.Compared with normal pregnancies,maternal serum concentrations of PlGF were lower in PE and maternal serum concentrations of sFlt-1 and ET-1 were higher in PE.7.Decreased PlGF and increased sFlt-1 in maternal serum were significantly associated with uterine arterial resistance in PE patients.8.The measurement of maternal serum PIGF and sFlt-1 may help in assessing perinatal outcomes.