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. 2022 Aug 10;14(16):3276.
doi: 10.3390/nu14163276.

Hypertensive Disorders of Pregnancy and Fetal Growth Restriction: Clinical Characteristics and Placental Lesions and Possible Preventive Nutritional Targets

Daniela Denis Di Martino  1 , Laura Avagliano  2 , Enrico Ferrazzi  1   3 , Federica Fusè  4 , Vittoria Sterpi  1 , Marco Parasiliti  1 , Tamara Stampalija  5   6 , Sara Zullino  7 , Antonio Farina  8 , Gaetano Pietro Bulfamante  2   9 , Matteo Di Maso  10 , Francesco D'Ambrosi  1
Affiliations

Hypertensive Disorders of Pregnancy and Fetal Growth Restriction: Clinical Characteristics and Placental Lesions and Possible Preventive Nutritional Targets

Daniela Denis Di Martino et al. Nutrients. .

Abstract

Background: The purpose of this study was to describe the placental lesions in pregnancies complicated by hypertensive disorders (HDP) and/or fetal growth restriction (FGR) and in uneventful control pregnancies.

Methods: This is a case control study that included singleton pregnancies with HDP and normally grown fetus (HDP-AGA fetus), with HDP and FGR, early FGR, late FGR, and uneventful pregnancies. Feto-placental Doppler velocimetry and sFlt-1/PlGF ratio were performed. Placental histology was evaluated blinded according to the Amsterdam Consensus criteria.

Results: Placental lesions with maternal vascular malperfusion (MVM) were significantly more frequent in HDP-FGR and early FGR (92% and 83%). MVM were significantly associated with abnormal feto-placental Doppler parameters, especially in early FGR. Delayed villous maturation (DVM) was associated with late FGR (83%). HDP-AGA fetus cases presented a heterogeneous pattern of placental lesions, including 60% of cases with MVM, but were not associated with abnormal Doppler feto-placental velocimetry.

Conclusions: We found a prevalence of placental maternal vascular malperfusion in HDP-FGR and early FGR groups. These lesions were also associated with abnormal, anti-, and angiogenic markers. Conversely HDP-AGA fetus and late FGR presented more heterogeneous placental lesions not severe enough to cause feto-placental Doppler anomalies. These conditions are likely associated with different etiologies, such as maternal pre-pregnancy risk factors for metabolic syndrome. These findings suggest a possible preventive nutritional approach in addition to low-dose aspirin in pregnant women with predisposing factors for HDP-AGA fetuses and late FGR.

Keywords: Mediterranean diet; fetal vascular malperfusion; feto-placental Doppler; maternal vascular malperfusion; placenta pathology; preeclampsia; sFlt-1/PlGF ratio.

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Conflict of interest statement

The authors declare no conflict of interest.

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