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Independent influences of maternal obesity and fetal sex on maternal cardiovascular adaptation to pregnancy: a prospective cohort study

Year: 2020
Type: article
Study design: Observational Study
Abstract: 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.
DOI: 10.1038/s41366-020-0627-2
Authors: Noor E. W. D. Teulings, Angela M. Wood, Ulla Sovio, Susan E. Ozanne, Gordon C. S. Smith, Catherine E. Aiken
Institutions: University of Cambridge, Rosie Hospital, NIHR Cambridge Biomedical Research Centre, Wellcome/MRC Institute of Metabolic Science, Addenbrooke's Hospital, MRC Metabolic Diseases Unit, Wellcome Trust
Language: English
Field: Medicine
Open Access status: hybrid
Estimated APC paid: $4,390
Funders: National Institute for Health and Care Research, British Heart Foundation, Department of Health and Social Care, University of Cambridge, Cambridge University Hospitals, Medical Research Council, NIHR Cambridge Biomedical Research Centre
Awards: G1671907826, Large-scale integrative genomic studies of high-dimensional traits in cardiovascular diseases (renewal), Cambridge 4th intake 2016 – 4-year PhD Studentship (3rd) Scheme: Mr Christian Doreth; Mr Ivelin Ivanov; Ms Noor Teulings; Ms Josca Schoonejans, G3607813749, G3986547339, Insulin and hypoxia: key determinants in the programming of cardiovascular disease by maternal obesity, Large-scale integrative studies of risk factors in coronary heart disease: from discovery to application (renewal). (Joint funding with MRC), G762219591, G7939076303, Large-scale integrative studies of risk factors in coronary heart disease: from discovery to application
OpenAlex ID: W3035001697
FWCI: 1.98
Cites: 53
Cited by: 28
Related to: 10