Characterisation of placental, fetal brain and maternal cardiac structure and function in pre-eclampsia using MRI
Authors: Hall Megan , de Marvao Antonio , Schweitzer Ronny , Cromb Daniel , Colford Kathleen , Jandu Priya , O’Regan Declan P , Ho Alison , Price Anthony , Chappell Lucy C. , Rutherford Mary A. , Story Lisa , Lamata Pablo , Hutter Jana 
Published: April 2023

Background

Pre-eclampsia is a multiorgan disease of pregnancy that has short- and long-term implications for the woman and fetus, whose immediate impact is poorly understood. We present a novel multi-system approach to MRI investigation of pre-eclampsia, with acquisition of maternal cardiac, placental, and fetal brain anatomical and functional imaging.

Methods

A prospective study was carried out recruiting pregnant women with pre-eclampsia, chronic hypertension, or no medical complications, and a non-pregnant female cohort. All women underwent a cardiac MRI, and pregnant women underwent a fetal-placental MRI. Cardiac analysis for structural, morphological and flow data was undertaken; placenta and fetal brain volumetric and T2* data were obtained. All results were corrected for gestational age.

Results

Seventy-eight MRIs were obtained during pregnancy. Pregnancies affected by pre-eclampsia demonstrated lower placental and fetal brain T2*. Within the pre-eclampsia group, three placental T2* results were within the normal range, these were the only cases with normal placental histopathology. Similarly, three fetal brain T2* results were within the normal range; these cases had no evidence of cerebral redistribution on fetal Dopplers. Cardiac MRI analysis demonstrated higher left ventricular mass in pre-eclampsia with 3D modelling revealing additional specific characteristics of eccentricity and outflow track remodelling.

Conclusions

We present the first holistic assessment of the immediate implications of pre-eclampsia on the placenta, maternal heart, and fetal brain. As well as having potential clinical implications for the risk-stratification and management of women with pre-eclampsia, this gives an insight into disease mechanism.

What is new?

We propose a comprehensive MRI protocol for maternal cardiac and fetal-placental imaging that is safe in pregnancy and acceptable to women, and report on the largest set of functional placental MRI data in pre-eclamptic pregnancies

The findings suggest altered oxygenation and microstructure in the placenta, which is associated with similar changes in the fetal brain

The study identifies a specific pattern of remodelling in the maternal left ventricle that is associated with pre-eclampsia

What are the clinical implications?

We demonstrate that MRI provides maternal and fetal insights into pre-eclamptic pregnancies that cannot be obtained by other means during pregnancy

Functional placental MRI may be able to differentiate between preeclampsia disease severities, while fetal brain imaging may help refine neurodevelopmental prognostic assessment of children exposed to pre-eclampsia in utero

A specific 3D pattern of left ventricular remodelling and thickening was found to be discriminant of the presence of pre-eclampsia and may provide a basis for improved clinical risk stratification