SEVERELY IMPAIRED FETAL GROWTH IS PRECEDED BY MATERNAL HEMODYNAMIC MALADAPTATION IN VERY EARLY-PREGNANCY

Objective. To test the hypothesis that in pregnancies complicated by i ntrauterine growth retardation (IUGR) maternal cardiovascular adaptati on is already abnormal in the first weeks of pregnancy. Setting. Unive rsity Hospital Maastricht, Maastricht, The Netherlands. Subjects. Four teen healthy pregnant women, recruited from the subfertility clinic. T en pregnancies were uneventful and four pregnancies resulted in the bi rth of growth retarded infants. Methods. Maternal cardiovascular statu s was followed longitudinally by combined M-mode and Doppler echocardi ography. Studies were performed weekly between the fifth and 10th week , at 14, 25 and 35 weeks and postpartum. Differences between the two g roups were analyzed by nonparametric tests. Results. In early pregnanc y the IUGR group differed from the normal group by a consistently smal ler left atrial diameter and a cardiac output that failed to increase. Postpartum the subjects in the IUGR group had a significantly smaller left atrial diameter and faster mean circumferential fiber shortening . Conclusion. Maternal hemodynamic adaptation in the first weeks of pr egnancy is defective in IUGR pregnancies, presumably associated with a concomitant inadequacy of the vascular filling state.