Fetal Growth and Placental Pathology in Maternal Hypertensive Diseases

Abstract

Among 252 pregnancies complicated by hypertension, the following associations were found: (1) At term, isolated chronic hypertension was associated with higher birthweight compared to normotensive controls and to preeclamptic pregnancies; only preeclampsia was independently related to low birthweight at term. (2) Preeclampsia was independently related to preterm intrauterine growth retardation as compared to normotensive preterm deliveries. (3) Decreased placental weight and the presence of placental infarction were both independently related to decreased birthweight and length (p<0.01). Decreased placental weight was inconsistently related to blood pressure elevation, and not independently related to other maternal characteristics. Placental infarction was associated with increasing levels of proteinuria. (4) Only proteinuria was associated with decreased fetal growth independent of placental pathology. We suggest that there is a “fetal syndrome” of chronic decreased fetal oxygenation and growth failure linked tightly to placental pathology, which may be poorly correlated with the degree of maternal hypertension. Hypertension in pregnancy is more likely to be accompanied by placental pathology and decreased fetal growth when severe proteinuria is present.