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

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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by core funding from the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z], by the NIH Human Placenta Project grant 1U01HD087202-01 (Placenta Imaging Project (PIP)), by the Wellcome Trust, Sir Henry Wellcome Fellowship to JH [201374/Z/16/Z] and Senior Research Fellowship to PL [209450/Z/17/Z]; National Institute for Health Research (NIHR) Imperial College Biomedical Research Centre; Medical Research Council (MC\_UP\_1605/13); British Heart Foundation (RG/19/6/34387, RE/18/4/34215); Academy of Medical Sciences (SGL015/1006). For the purpose of open access, the authors have applied a creative commons attribution (CC BY) licence to any author accepted manuscript version arising. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: London Dulwich Ethics Committee 08/LO/1958 and 16/LO/1573. London - West London & GTAC Research Ethics Committee 17/LO/0034. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data that support the findings of this study are available from the corresponding author, MH, upon reasonable request.