Characterisation of placental, fetal brain and maternal cardiac structure and function in pre-eclampsia using MRI

BackgroundPre-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. MethodsA 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. ResultsSeventy-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. ConclusionsWe 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?O_LIWe 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 C_LIO_LIThe findings suggest altered oxygenation and microstructure in the placenta, which is associated with similar changes in the fetal brain C_LIO_LIThe study identifies a specific pattern of remodelling in the maternal left ventricle that is associated with pre-eclampsia C_LI What are the clinical implications?O_LIWe demonstrate that MRI provides maternal and fetal insights into pre-eclamptic pregnancies that cannot be obtained by other means during pregnancy C_LIO_LIFunctional 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 C_LIO_LIA 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 C_LI