Independent influences of maternal obesity and fetal sex on maternal cardiovascular adaptation to pregnancy: a prospective cohort study.
Journal
International journal of obesity (2005)
ISSN: 1476-5497
Titre abrégé: Int J Obes (Lond)
Pays: England
ID NLM: 101256108
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
20
12
2019
accepted:
01
06
2020
revised:
24
04
2020
pubmed:
17
6
2020
medline:
4
11
2021
entrez:
17
6
2020
Statut:
ppublish
Résumé
Successful pregnancy requires the de novo creation of low-resistance utero-placental and feto-placental circulations and incomplete remodeling of this vasculature can lead to maternal or fetal compromise. Maternal BMI and fetal sex are known to influence vascular compliance and placental development, but it is unknown if these are independent or synergistic effects. Here we aim to investigate the impact of maternal obesity, fetal sex, and any interaction thereof on maternal cardiovascular adaptation to pregnancy, by assessing the physiological drop of uterine artery doppler pulsatility (UtA-PI) and umbilical artery doppler pulsatility index (UA-PI) over gestation. Nulliparous women with a singleton pregnancy participating in a prospective cohort study (n = 4212) underwent serial UtA-PI and UA-PI measurements at 20-, 28- and 36-weeks gestation. Linear mixed regression models were employed to investigate the influence of maternal BMI, fetal sex and interactions thereof on the magnitude of change in UtA-PI and UA-PI. Throughout gestation, UtA-PI was higher for male fetuses and UA-PI was higher for female fetuses. The physiological drop of UtA-PI was significantly smaller in overweight (change -24.3% [95%CI -22.3, -26.2]) and obese women (change -21.3% [-18.3, -24.3]), compared to normal-weight women (change -25.7% [-24.3, -27.0]) but did not differ by fetal sex. The physiological drop in UA-PI was greater for female than male fetuses (-32.5% [-31.5, -33.5] vs. -30.7% [-29.8, -31.7]) but did not differ by maternal BMI. No interactions between maternal BMI and fetal sex were found. Maternal cardiovascular adaptation to pregnancy is independently associated with maternal BMI and fetal sex. Our results imply sexual dimorphism in both maternal cardiovascular adaptation and feto-placental resistance.
Sections du résumé
BACKGROUND/OBJECTIVES
Successful pregnancy requires the de novo creation of low-resistance utero-placental and feto-placental circulations and incomplete remodeling of this vasculature can lead to maternal or fetal compromise. Maternal BMI and fetal sex are known to influence vascular compliance and placental development, but it is unknown if these are independent or synergistic effects. Here we aim to investigate the impact of maternal obesity, fetal sex, and any interaction thereof on maternal cardiovascular adaptation to pregnancy, by assessing the physiological drop of uterine artery doppler pulsatility (UtA-PI) and umbilical artery doppler pulsatility index (UA-PI) over gestation.
SUBJECTS/METHODS
Nulliparous women with a singleton pregnancy participating in a prospective cohort study (n = 4212) underwent serial UtA-PI and UA-PI measurements at 20-, 28- and 36-weeks gestation. Linear mixed regression models were employed to investigate the influence of maternal BMI, fetal sex and interactions thereof on the magnitude of change in UtA-PI and UA-PI.
RESULTS
Throughout gestation, UtA-PI was higher for male fetuses and UA-PI was higher for female fetuses. The physiological drop of UtA-PI was significantly smaller in overweight (change -24.3% [95%CI -22.3, -26.2]) and obese women (change -21.3% [-18.3, -24.3]), compared to normal-weight women (change -25.7% [-24.3, -27.0]) but did not differ by fetal sex. The physiological drop in UA-PI was greater for female than male fetuses (-32.5% [-31.5, -33.5] vs. -30.7% [-29.8, -31.7]) but did not differ by maternal BMI. No interactions between maternal BMI and fetal sex were found.
CONCLUSIONS
Maternal cardiovascular adaptation to pregnancy is independently associated with maternal BMI and fetal sex. Our results imply sexual dimorphism in both maternal cardiovascular adaptation and feto-placental resistance.
Identifiants
pubmed: 32541920
doi: 10.1038/s41366-020-0627-2
pii: 10.1038/s41366-020-0627-2
pmc: PMC7577853
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2246-2255Subventions
Organisme : Medical Research Council
ID : MC_UU_12012/4
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/L003120/1
Pays : United Kingdom
Organisme : British Heart Foundation
ID : RG/18/13/33946
Pays : United Kingdom
Organisme : British Heart Foundation
ID : RG/13/13/30194
Pays : United Kingdom
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