American journal of obstetrics and gynecology · 2026
What does uterine artery Doppler reflect in late pregnancy? Insights from angiogenic, hemodynamic, and vascular markers in preeclampsia.
СтатьяНазвание и аннотация: Перевод в очереди
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Chatzakis Christos, Mansukhani Tanvi, Bhojwani Disha, Harris-Wood Megan, Charakida Marietta, Nicolaides Kypros H
Аннотация
BACKGROUND: Preeclampsia is a complex disorder arising from abnormal placentation and maternal vascular maladaptation. Uterine artery Doppler is widely used to assess placental perfusion in early pregnancy. However, in late pregnancy its role remains unclear.
OBJECTIVE: To investigate the mechanisms linking uterine artery Doppler findings at 35 to 36 weeks' gestation with preeclampsia by quantifying the contribution of placental angiogenic, hemodynamic, and vascular pathways.
STUDY DESIGN: This prospective observational study included 11,962 singleton pregnancies undergoing routine assessment at 35+0 to 36+6 weeks' gestation in a tertiary center in London, UK, between 2021 and 2024. Uterine artery pulsatility index, placental angiogenic biomarkers [placental growth factor and soluble fms-like tyrosine kinase-1], hemodynamic indices [ophthalmic artery peak systolic velocity ratio], and arterial stiffness [carotid to femoral pulse wave velocity] were measured. Mediation analysis quantified indirect (average causal mediation effect) and direct effects. Multivariable logistic regression assessed independent associations with preeclampsia.
RESULTS: Preeclampsia occurred in 349 (2.9%) pregnancies. Mediation analysis demonstrated that placental angiogenic imbalance accounted for the largest proportion of the association between uterine artery Doppler and preeclampsia, with placental growth factor mediating approximately 40% and soluble fms-like tyrosine kinase-1 approximately 9% of the total effect. The ophthalmic artery ratio mediated approximately 15% of the association. In contrast, carotid to femoral pulse wave velocity did not demonstrate significant mediation. In multivariable models incorporating angiogenic, hemodynamic, and vascular parameters, uterine artery Doppler was no longer independently associated with preeclampsia (β=0.11, P=.13). Higher soluble fms-like tyrosine kinase-1, higher ophthalmic artery ratio, and increased arterial stiffness were independently associated with increased risk, whereas higher placental growth factor was strongly protective (all P<.001).
CONCLUSION: Uterine artery Doppler in late pregnancy appears to reflect biological processes related to placental and hemodynamic dysfunction, predominantly placental.
OBJECTIVE: To investigate the mechanisms linking uterine artery Doppler findings at 35 to 36 weeks' gestation with preeclampsia by quantifying the contribution of placental angiogenic, hemodynamic, and vascular pathways.
STUDY DESIGN: This prospective observational study included 11,962 singleton pregnancies undergoing routine assessment at 35+0 to 36+6 weeks' gestation in a tertiary center in London, UK, between 2021 and 2024. Uterine artery pulsatility index, placental angiogenic biomarkers [placental growth factor and soluble fms-like tyrosine kinase-1], hemodynamic indices [ophthalmic artery peak systolic velocity ratio], and arterial stiffness [carotid to femoral pulse wave velocity] were measured. Mediation analysis quantified indirect (average causal mediation effect) and direct effects. Multivariable logistic regression assessed independent associations with preeclampsia.
RESULTS: Preeclampsia occurred in 349 (2.9%) pregnancies. Mediation analysis demonstrated that placental angiogenic imbalance accounted for the largest proportion of the association between uterine artery Doppler and preeclampsia, with placental growth factor mediating approximately 40% and soluble fms-like tyrosine kinase-1 approximately 9% of the total effect. The ophthalmic artery ratio mediated approximately 15% of the association. In contrast, carotid to femoral pulse wave velocity did not demonstrate significant mediation. In multivariable models incorporating angiogenic, hemodynamic, and vascular parameters, uterine artery Doppler was no longer independently associated with preeclampsia (β=0.11, P=.13). Higher soluble fms-like tyrosine kinase-1, higher ophthalmic artery ratio, and increased arterial stiffness were independently associated with increased risk, whereas higher placental growth factor was strongly protective (all P<.001).
CONCLUSION: Uterine artery Doppler in late pregnancy appears to reflect biological processes related to placental and hemodynamic dysfunction, predominantly placental.