Delivery of a growth-restricted offspring and the association with early-onset impaired maternal endothelial function

Background Women who have had small for gestational age offspring have an increased risk of cardiovascular disease in later life. Endothelial dysfunction is a subclinical sign of early cardiovascular disease. It is unknown whether women who have recently had a pregnancy complicated by fetal growth restriction, in the absence of other maternal and fetal disease, have subclinical endothelial dysfunction. Objective To assess maternal endothelial function six months after a pregnancy complicated by fetal growth restriction. Methods This was a case–control study, conducted in a tertiary referral hospital in London over a 15-month period. Flow-mediated dilatation (FMD) of the brachial artery was measured in women, six months (+/− 2.5 months) after the birth of their child. Forty-four women were studied; 15 had a growth restricted offspring (customised birth centile 1.9 ± 2.3; mean ± SD) and 29 women had delivered an appropriately grown baby (customized birth centile 47.5 ± 26.3). Results were analysed using an unpaired t-test and the means of the primary continuous variable (FMD % change). Results Women who had a growth restricted offspring had lower postpartum FMD (6.79% ± 0.95%) compared with mothers who had an appropriately grown offspring, FMD 10.26% ± 2.44%; 95% CI −5.37 to −1.57 (p = 0.0007;). There were no differences in postnatal measures of maternal blood pressure, abdominal circumference, weight, glucose, insulin and lipid profiles between the two groups. Conclusions Within six months of childbirth, women who have had a pregnancy affected by fetal growth restriction due to likely placental failure, but in the absence of pre-eclampsia, have evidence of subclinical endothelial dysfunction. These women may benefit from lifestyle measures focused on the primary prevention of cardiovascular disease. Further research, with larger populations, is needed to discover whether this postpartum maternal endothelial dysfunction is a pregnancy-induced phenomenon, or related to pre-existing maternal phenotype and indeed whether it persists long term.