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Uterine artery blood flow, fetal hypoxia and fetal growth

Philosophical transactions of the Royal Society of London. Series B. Biological sciences, 2015-03, Vol.370 (1663), p.20140068-20140068 [Peer Reviewed Journal]

2015 The Author(s) Published by the Royal Society. All rights reserved. ;2015 The Author(s) Published by the Royal Society. All rights reserved. 2015 ;ISSN: 0962-8436 ;EISSN: 1471-2970 ;DOI: 10.1098/rstb.2014.0068 ;PMID: 25602072

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  • Title:
    Uterine artery blood flow, fetal hypoxia and fetal growth
  • Author: Browne, Vaughn A. ; Julian, Colleen G. ; Toledo-Jaldin, Lillian ; Cioffi-Ragan, Darleen ; Vargas, Enrique ; Moore, Lorna G.
  • Subjects: Altitude ; Biological Evolution ; Brain Sparing ; Doppler Velocimetry ; Female ; Fetal Biometry ; Fetal Development - physiology ; Fetal Hypoxia - physiopathology ; Fetus - blood supply ; Heart Rate - physiology ; High-Altitude Adaptation ; Humans ; Intrauterine Growth Restriction ; Models, Biological ; Pregnancy ; Regional Blood Flow - physiology ; Uterine Artery - physiology
  • Is Part Of: Philosophical transactions of the Royal Society of London. Series B. Biological sciences, 2015-03, Vol.370 (1663), p.20140068-20140068
  • Description: Evolutionary trade-offs required for bipedalism and brain expansion influence the pregnancy rise in uterine artery (UtA) blood flow and, in turn, reproductive success. We consider the importance of UtA blood flow by reviewing its determinants and presenting data from 191 normotensive (normal, n = 125) or hypertensive (preeclampsia (PE) or gestational hypertension (GH), n = 29) Andean residents of very high (4100–4300 m) or low altitude (400 m, n = 37). Prior studies show that UtA blood flow is reduced in pregnancies with intrauterine growth restriction (IUGR) but whether the IUGR is due to resultant fetal hypoxia is unclear. We found higher UtA blood flow and Doppler indices of fetal hypoxia in normotensive women at high versus low altitude but similar fetal growth. UtA blood flow was markedly lower in early-onset PE versus normal high-altitude women, and their fetuses more hypoxic as indicated by lower fetal heart rate, Doppler indices and greater IUGR. We concluded that, despite greater fetal hypoxia, fetal growth was well defended by higher UtA blood flows in normal Andeans at high altitude but when compounded by lower UtA blood flow in early-onset PE, exaggerated fetal hypoxia caused the fetus to respond by decreasing cardiac output and redistributing blood flow to help maintain brain development at the expense of growth elsewhere. We speculate that UtA blood flow is not only an important supply line but also a trigger for stimulating the metabolic and other processes regulating feto-placental metabolism and growth. Studies using the natural laboratory of high altitude are valuable for identifying the physiological and genetic mechanisms involved in human reproductive success.
  • Publisher: England: The Royal Society
  • Language: English
  • Identifier: ISSN: 0962-8436
    EISSN: 1471-2970
    DOI: 10.1098/rstb.2014.0068
    PMID: 25602072
  • Source: Geneva Foundation Free Medical Journals at publisher websites
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    PubMed Central
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