Fetal growth is associated with first‐trimester maternal vascular function

• Published in: Ultrasound in obstetrics & gynecology 2016-10, Vol.48 (4), p.483-490
• Main Authors: Iacobaeus, C., Kahan, T., Jörneskog, G., Bremme, K., Thorsell, M., Andolf, E.
• Format: Article
• Language: English
• Subjects: Adult; Birth Weight; Brachial Artery - physiology; Cross-Sectional Studies; endothelial function; Female; Fetal Development; fetal growth; Forearm - blood supply; Humans; Hyperemia - etiology; Laser-Doppler Flowmetry; Male; Maternal Age; Microcirculation; Nitroglycerin - administration & dosage; Nitroglycerin - pharmacology; Pregnancy; Pregnancy Trimester, First; vascular; Vasodilation - drug effects
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.15863

ABSTRACT Objective To investigate the relationship between maternal endothelial function in the first trimester, assessed in both the brachial artery and the forearm skin microcirculation, and fetal growth. Methods Vascular function was assessed in 56 pregnant women during gestational weeks 11–14. Vascular reactivity in the brachial artery was evaluated by postischemic hyperemia‐induced flow‐mediated vasodilatation (FMD) and by vasodilatation following administration of sublingual glyceryl trinitrate (GTN). Forearm skin microcirculation was investigated by laser Doppler perfusion imaging during iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) to assess endothelium‐dependent and ‐independent microvascular vasodilatation, respectively. Fetal growth was measured at study inclusion and birth‐weight centile was calculated after delivery. Results FMD and GTN‐induced vasodilatation were both associated with birth‐weight centile. On multivariate analysis (adjusted for brachial artery diameter at rest, blood pressure, maternal age and heart rate), for FMD β = 1.7 (95% CI, 0.06–3.34), r2 = 0.26 and P = 0.042, and for GTN‐induced vasodilatation β = 2.6 (95% CI, 0.44–4.68), r2 = 0.15 and P = 0.02. Endothelium‐dependent and ‐independent microvascular reactivity were also associated with birth‐weight centile: for ACh β = 7.82 (95% CI, 1.81–13.83), r2 = 0.12 and P = 0.029, and for SNP β = 6.27 (95% CI, 1.20–11.34), r2 = 0.11 and P = 0.016. Conclusion First‐trimester maternal vascular dilatation capacity (rather than endothelial function alone) is associated with fetal growth. These findings were consistent in both the brachial artery and the forearm skin microcirculation. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.