Fetal pulmonary vascular volume is impaired in mothers with early onset preeclampsia - a proof of concept study.

OBJECTIVES

Children of mothers with early-onset preeclampsia (EOPE) are at increased risk of respiratory morbidity due to factors including fetal growth restriction, prematurity, and impaired pulmonary vascular development. While animal studies suggest compromised fetal pulmonary vasculature in preeclampsia, human data remain limited. This study aimed to compare fetal pulmonary vascular volume in EOPE pregnancies with healthy controls as a proof of concept.

STUDY DESIGN AND MAIN OUTCOME MEASURES: Pregnant women with EOPE and healthy controls were prospectively recruited. Ultrasound assessments were performed at three gestational intervals: 19 + 0-24 + 0 weeks (US1), 24 + 1-29 + 6 weeks (US2), and 30 + 0-32 + 0 weeks (US3). Using 3D Power Doppler ultrasound, fetal right pulmonary vascular volume (R-PVV), right lung volume (R-LV), and the R-PVV/LV ratio were measured. Perinatal parameters were also evaluated.

RESULTS

Seventy-two controls and 36 EOPE fetuses were included. EOPE fetuses showed significantly reduced R-PVV at US2 and US3 compared to controls. The R-PVV/LV ratio remained significantly lower at both time points, suggesting impaired vascular development independent of lung size. Maternal BMI, gestational age at birth, and neonatal outcomes differed significantly between groups.

CONCLUSIONS

This is the first human study to demonstrate impaired fetal pulmonary vascular development in EOPE. These findings offer insight into the pathophysiological effects of EOPE on fetal lung health.