{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:09:53Z","timestamp":1778126993961,"version":"3.51.4"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To test the hypotheses that estimated mean pulmonary arterial pressure (MPAP) decreases and pulmonary vascular maturation, assessed by the ratio of pulmonary arterial flow acceleration time to ejection time (AT\/ET ratio), increases after reversal of fetal ductus arteriosus constriction by reducing maternal intake of the causal agent (prostaglandin inhibitors, such as polyphenol\u2010rich foods or non\u2010steroidal anti\u2010inflammatory drugs), and that these effects are independent of gestational age, which are inferences not yet demonstrated in the clinical setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective cohort study comparing Doppler echocardiographic ductal flow dynamics, MPAP and pulmonary arterial flow AT\/ET ratio in third\u2010trimester fetuses (\u2265\u200928\u2009weeks' gestation) with ductus arteriosus constriction, at the time of diagnosis and after 2\u2009weeks of reduced maternal intake of prostaglandin inhibitors either by suspending the use of pharmacological agents with potential for prostaglandin inhibition or by restricting the consumption of polyphenol\u2010rich foods. MPAP was estimated using the Dabestani equation (MPAP\u2009=\u200990\u2009\u2212\u2009(0.62\u2009\u00d7\u2009AT)), and pulmonary vascular maturity was assessed using the AT\/ET ratio, according to reported validation studies. Student's <jats:italic>t<\/jats:italic>\u2010test was used for comparison of variables at diagnosis with those after reversal of ductal constriction. Change in MPAP and pulmonary AT\/ET ratio between the two assessments was compared with the expected change in the same gestational period in normal fetuses based on reference curves of MPAP and pulmonary AT\/ET ratio constructed in normal fetuses from healthy pregnant women at 19\u201337\u2009weeks' gestation, encompassing the same gestational age range as the study group (28\u201337\u2009weeks).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy pregnancies with fetal ductus arteriosus constriction were included in the study. After 2\u2009weeks of reduced maternal intake of prostaglandin inhibitors, normalization of mean systolic (change from 1.86\u2009\u00b1\u20090.34\u2009m\/s at diagnosis to 1.38\u2009\u00b1\u20090.41\u2009m\/s; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and diastolic (change from 0.41\u2009\u00b1\u20090.11\u2009m\/s to 0.21\u2009\u00b1\u20090.065\u2009m\/s; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) ductal velocities and of mean pulsatility index (change from 1.99\u2009\u00b1\u20090.20 to 2.55\u2009\u00b1\u20090.42; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) was demonstrated. MPAP decreased between the assessments (change from 66.7\u2009\u00b1\u20096.90\u2009mmHg at diagnosis to 54.5\u2009\u00b1\u20096.70\u2009mmHg after 2\u2009weeks; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and mean pulmonary AT\/ET ratio increased (change from 0.20\u2009\u00b1\u20090.06 to 0.33\u2009\u00b1\u20090.07; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Change in MPAP between diagnosis and after 2\u2009weeks of reduced maternal intake of prostaglandin inhibitors was \u221212.2\u2009\u00b1\u20090.30\u2009mmHg, which was 5.3\u2010times higher than that in 305 normal fetuses over 2\u2009weeks during the same gestational period (\u22122.3\u2009\u00b1\u20090.19\u2009mmHg) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and change in pulmonary AT\/ET ratio between the two assessments was 0.13\u2009\u00b1\u20090.08, which was 8.7\u2010times higher than that in normal fetuses in the same gestational period (0.015\u2009\u00b1\u20090.08) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Resolution of fetal ductal constriction is followed by a fall in MPAP and by an increase in pulmonary vascular maturity, to a significantly greater degree than is observed in normal fetuses in the same gestational\u2010age period. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23599","type":"journal-article","created":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T13:11:57Z","timestamp":1611753117000},"page":"420-427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Improvement in fetal pulmonary hypertension and maturity after reversal of ductal constriction: prospective cohort study"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9268-1450","authenticated-orcid":false,"given":"P.","family":"Zielinsky","sequence":"first","affiliation":[{"name":"Fetal Cardiology Unit Institute of Cardiology  Porto Alegre Brazil"},{"name":"Department of Pediatrics Federal University of Rio Grande do Sul  Porto Alegre Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. 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