{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T09:02:01Z","timestamp":1785488521425,"version":"3.56.0"},"reference-count":95,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Fetal growth restriction (FGR) has traditionally been attributed to placental insufficiency. However, accumulating evidence suggests that maternal cardiovascular maladaptation contributes to disease expression, clinical heterogeneity, and long-term maternal cardiovascular risk. To review maternal echocardiographic findings in pregnancies complicated by FGR, with or without preeclampsia and to explore the role of cardiovascular phenotyping in risk stratification and clinical management. Narrative review of the current literature, including observational studies, systematic reviews, meta-analyses, and expert consensus statements on maternal hemodynamics and echocardiographic assessment in FGR. FGR is associated with a maladaptive cardiovascular profile characterized by reduced cardiac output, increased systemic vascular resistance and adverse cardiac remodeling. Echocardiography frequently identifies subclinical myocardial dysfunction, including impaired diastolic function and reduced global longitudinal strain despite preserved ejection fraction. Distinct maternal cardiovascular phenotypes emerge across the FGR spectrum, ranging from high-risk hypodynamic, resistance-dominant phenotypes to intermediate and low-risk phenotypes with preserved hemodynamic adaptation. Integration of maternal cardiovascular assessment with fetal Doppler findings may improve risk stratification and support phenotype-guided surveillance and therapeutic decision-making. Persistent postpartum cardiovascular abnormalities further support the concept of pregnancy as a cardiovascular stress test and identify women at increased long-term cardiovascular risk. FGR should be viewed as the clinical manifestation of a complex maternal\u2013placental\u2013cardiovascular interaction rather than an isolated placental disorder. Maternal cardiovascular phenotyping has the potential to refine risk stratification, support hemodynamic-guided management, and identify women who may benefit from structured long-term cardiovascular surveillance.<\/jats:p>","DOI":"10.3390\/diagnostics16152414","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:20:18Z","timestamp":1785486018000},"page":"2414","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Cardiovascular Phenotype in Fetal Growth Restriction with or Without Pre-Eclampsia: Insights from Echocardiography and Clinical Implications"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0310-1132","authenticated-orcid":false,"given":"Dorina-Adelina","family":"Minciuna","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai Stefan Cristian","family":"Haba","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"\u201cSaint Spiridon\u201d County Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1955-3521","authenticated-orcid":false,"given":"Raluca-Maria","family":"Haba","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8501-2160","authenticated-orcid":false,"given":"Cosmin-Daniel","family":"Minciuna","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9112-7039","authenticated-orcid":false,"given":"Alexandru","family":"Carauleanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cCuza Voda\u201d, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-699X","authenticated-orcid":false,"given":"Ioana-Sadiye","family":"Scripcariu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cCuza Voda\u201d, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1627-4480","authenticated-orcid":false,"given":"Cristina","family":"David","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cCuza Voda\u201d, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela-Cristina","family":"Dimitriu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cCuza Voda\u201d, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0979-0200","authenticated-orcid":false,"given":"Demetra-Gabriela","family":"Socolov","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cCuza Voda\u201d, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref_1","first-page":"447","article-title":"Metabolomic identification of placental alterations in fetal growth restriction","volume":"35","author":"Turkoglu","year":"2020","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_2","unstructured":"Chew, L.C., Osuchukwu, O.O., Reed, D.J., and Verma, R.P. (2026, April 26). Fetal Growth Restriction, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK562268\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ogc.2021.02.002","article-title":"Abnormal Fetal Growth: Small for Gestational Age, Fetal Growth Restriction, Large for Gestational Age: Definitions and Epidemiology","volume":"48","author":"Damhuis","year":"2021","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lubrano, C., Taricco, E., Coco, C., Di Domenico, F., Mand\u00f2, C., and Cetin, I. (2022). Perinatal and Neonatal Outcomes in Fetal Growth Restriction and Small for Gestational Age. J. Clin. Med., 11.","DOI":"10.3390\/jcm11102729"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/uog.15884","article-title":"Consensus definition of fetal growth restriction: A Delphi procedure","volume":"48","author":"Gordijn","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1002\/uog.22134","article-title":"ISUOG Practice Guidelines: Diagnosis and management of small-for-gestational-age fetus and fetal growth restriction","volume":"56","author":"Lees","year":"2020","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ijgo.13522","article-title":"FIGO (International Federation of Gynecology and Obstetrics) initiative on fetal growth: Best practice advice for screening, diagnosis, and management of fetal growth restriction","volume":"152","author":"Melamed","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1055\/a-1232-1418","article-title":"Fetal Growth Restriction\u2014Diagnostic Work-up, Management and Delivery","volume":"80","author":"Schlembach","year":"2020","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2020.05.010","article-title":"Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction","volume":"223","author":"Martins","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/uog.70017","article-title":"Delphi consensus definition of fetal growth restriction after 8 years: Implementation and future directions","volume":"66","author":"Bruins","year":"2025","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e28007","DOI":"10.1016\/j.heliyon.2024.e28007","article-title":"FGR-associated placental insufficiency and capillary angiogenesis involves disruptions in human placental miRNAs and mRNAs","volume":"10","author":"Song","year":"2024","journal-title":"Heliyon"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1161\/HYPERTENSIONAHA.112.194159","article-title":"Maternal Cardiovascular Impairment in Pregnancies Complicated by Severe Fetal Growth Restriction","volume":"60","author":"Melchiorre","year":"2012","journal-title":"Hypertension"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"312.e1","DOI":"10.1016\/j.ajog.2024.05.015","article-title":"Maternal cardiovascular profile is altered in the preclinical phase of normotensive early and late intrauterine growth restriction","volume":"232","author":"Vasapollo","year":"2025","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e032673","DOI":"10.1161\/JAHA.123.032673","article-title":"Third-Trimester Cardiovascular Function and Risk of Hypertensive Disorders of Pregnancy","volume":"13","author":"Lihme","year":"2024","journal-title":"JAHA"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mannarino, S., Calcaterra, V., Garella, V., Puricelli, F., Baj, B., Quatrale, A., Gazzola, C., Nosvelli, A., Raso, I., and Zuccotti, G. (2026). The Impact of Fetal Growth Restriction on Myocardial Development from Fetal Life to Early Childhood: A Narrative Review. Children, 13.","DOI":"10.3390\/children13030312"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/jcu.23392","article-title":"An update on maternal cardiac hemodynamics in fetal growth restriction and pre-eclampsia","volume":"51","author":"Minopoli","year":"2023","journal-title":"J. Clin. Ultrasound"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gyselaers, W., and Lees, C. (2022). Maternal Low Volume Circulation Relates to Normotensive and Preeclamptic Fetal Growth Restriction. Front. Med., 9.","DOI":"10.3389\/fmed.2022.902634"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1042\/CS20211130","article-title":"Placental syndromes and maternal cardiovascular health","volume":"137","author":"Casey","year":"2023","journal-title":"Clin. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1161\/HYPERTENSIONAHA.118.11191","article-title":"Cardiovascular System in Preeclampsia and Beyond","volume":"73","author":"Thilaganathan","year":"2019","journal-title":"Hypertension"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/uog.20419","article-title":"Are maternal hemodynamic indices markers of fetal growth restriction in pregnancies with a small-for-gestational-age fetus?","volume":"55","author":"Perry","year":"2020","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_21","unstructured":"Yinon, Y., and Kingdom, J.C.P. (2026, April 26). Vascular Dysfunction in Women with a History of Preeclampsia and Intrauterine Growth Restriction. Available online: https:\/\/www.ahajournals.org\/doi\/epub\/10.1161\/CIRCULATIONAHA.110.948455."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1161\/HYPERTENSIONAHA.110.162321","article-title":"Maternal Cardiac Dysfunction and Remodeling in Women with Preeclampsia at Term","volume":"57","author":"Melchiorre","year":"2011","journal-title":"Hypertension"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1002\/uog.70040","article-title":"ISUOG Consensus Statement on maternal hemodynamic assessment in hypertensive disorders of pregnancy and fetal growth restriction","volume":"66","author":"Stampalija","year":"2025","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S745","DOI":"10.1016\/j.ajog.2017.11.577","article-title":"Pathophysiology of placental-derived fetal growth restriction","volume":"218","author":"Burton","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.ajog.2010.08.009","article-title":"The \u201cGreat Obstetrical Syndromes\u201d are associated with disorders of deep placentation","volume":"204","author":"Brosens","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S1006","DOI":"10.1016\/j.ajog.2020.10.052","article-title":"Preeclampsia has two phenotypes which require different treatment strategies","volume":"226","author":"Masini","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"R210","DOI":"10.1152\/ajpregu.00075.2018","article-title":"Gestational hypertensive disorders show unique patterns of circulatory deterioration with ongoing pregnancy","volume":"316","author":"Gyselaers","year":"2019","journal-title":"Am. J. Physiol.-Regul. Integr. Comp. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/aogs.70102","article-title":"Hemodynamic changes in pregnancies with impaired fetal growth: A systematic review and meta-analysis","volume":"105","author":"Kempener","year":"2026","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1002\/uog.17340","article-title":"Longitudinal maternal hemodynamics in pregnancies affected by fetal growth restriction","volume":"49","author":"Stott","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1111\/aogs.14026","article-title":"Hemodynamic findings in normotensive women with small-for-gestational-age and growth-restricted fetuses","volume":"100","author":"Ghi","year":"2021","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S988","DOI":"10.1016\/j.ajog.2021.11.022","article-title":"Hemodynamic pathways of gestational hypertension and preeclampsia","volume":"226","author":"Gyselaers","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1002\/uog.18952","article-title":"Assessment of venous hemodynamics and volume homeostasis during pregnancy: Recommendations of the International Working Group on Maternal Hemodynamics","volume":"52","author":"Gyselaers","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.preghy.2018.05.008","article-title":"Angiogenic biomarkers in triage and risk for preeclampsia with severe features","volume":"13","author":"Rana","year":"2018","journal-title":"Pregnancy Hypertens."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Papapanagiotou, A., Daskalaki, M.A., Gargalionis, A.N., Margoni, A., Domali, A., Daskalakis, G., and Papavassiliou, A.G. (2025). The Role of Angiogenetic Factors in Preeclampsia. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262110431"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1111\/aogs.14546","article-title":"The sFlt1\/PlGF ratio predicts faster fetal deterioration in early fetal growth restriction: A historical cohort study","volume":"102","author":"Meneses","year":"2023","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kutllovci Hasani, K., Ajeti, N., and Goswami, N. (2025). Understanding Preeclampsia: Cardiovascular Pathophysiology, Histopathological Insights and Molecular Biomarkers. Med. Sci., 13.","DOI":"10.3390\/medsci13030154"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Kariori, M., Katsi, V., and Tsioufis, C. (2025). Late vs. Early Preeclampsia. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262211091"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1161\/CIRCULATIONAHA.114.009029","article-title":"Cardiovascular Physiology of Pregnancy","volume":"130","author":"Sanghavi","year":"2014","journal-title":"Circulation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1111\/j.1471-0528.2006.01013.x","article-title":"Maternal total vascular resistance and concentric geometry: A key to identify uncomplicated gestational hypertension","volume":"113","author":"Valensise","year":"2006","journal-title":"BJOG"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"4956","DOI":"10.1038\/s41598-026-35615-1","article-title":"Echocardiographic investigation of maternal cardiac physiological adaptations in Chinese pregnancies","volume":"16","author":"Chen","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Meena, P., and Batool, A. (2026). Electrolyte homeostasis in pregnancy: From physiological adaptations to clinical disturbances\u2014A nephrologist\u2019s perspective. Front. Nephrol., 6.","DOI":"10.3389\/fneph.2026.1773415"},{"key":"ref_42","unstructured":"Kepley, J.M., Bates, K., and Mohiuddin, S.S. (2026, May 04). Physiology, Maternal Changes, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK539766\/."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"13","DOI":"10.14797\/mdcvj.1323","article-title":"Valvular Heart Disease in Pregnancy","volume":"20","author":"Shapiro","year":"2024","journal-title":"Methodist DeBakey Cardiovasc. J."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Das, B.B., Kwan, M.D., and Upadhyay, S. (2026). Contemporary Management of Heart Failure in Pregnant Women with Adult Congenital Heart Disease: Emerging Challenges and Future Directions. J. Card. Fail.-Intersect., in press.","DOI":"10.1016\/j.yjcafi.2026.01.010"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1016\/j.hlc.2020.10.001","article-title":"Physiological Changes and Cardiovascular Investigations in Pregnancy","volume":"30","author":"Morton","year":"2021","journal-title":"Heart Lung Circ."},{"key":"ref_46","first-page":"200316","article-title":"Alterations in maternal cardiovascular parameters and their impact on uterine and fetal circulation in hypertensive pregnancies and fetal growth restriction","volume":"22","author":"Maseliene","year":"2024","journal-title":"Int. J. Cardiol. Cardiovasc. Risk Prev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"H1469","DOI":"10.1152\/ajpheart.00052.2024","article-title":"Understanding changes in echocardiographic parameters at different ages following fetal growth restriction: A systematic review and meta-analysis","volume":"326","author":"Nijholt","year":"2024","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"H191","DOI":"10.1152\/ajpheart.00055.2024","article-title":"Guidelines for assessing maternal cardiovascular physiology during pregnancy and postpartum","volume":"327","author":"Collins","year":"2024","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/OGX.0000000000000811","article-title":"Speckle Tracking Echocardiography in Hypertensive Pregnancy Disorders: A Systematic Review","volume":"75","author":"Moors","year":"2020","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1002\/pd.70145","article-title":"Cardiac Function in Fetal Growth Restriction: A Systematic Review and Meta-Analysis","volume":"46","author":"Mappa","year":"2026","journal-title":"Prenat. Diagn."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Chen, Y., Huang, M., Shi, D., Lin, J., Guo, J., Yang, Y., Li, S., and Lyu, G. (2025). Correlation between fetal-placental doppler indices and maternal cardiac function in pregnant women with late-Onset preeclampsia or fetal growth restriction. BMC Pregnancy Childbirth, 25.","DOI":"10.1186\/s12884-025-07848-x"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1007\/s43032-020-00393-2","article-title":"Fetal Growth Restriction: Does an Integrated Maternal Hemodynamic-Placental Model Fit Better?","volume":"28","author":"Mecacci","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_53","unstructured":"Bruss, Z.S., and Raja, A. (2026, May 05). Physiology, Stroke Volume, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK547686\/."},{"key":"ref_54","unstructured":"King, J., and Lowery, D.R. (2026, May 05). Physiology, Cardiac Output, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470455\/."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1111\/j.1471-0528.2006.00945.x","article-title":"Maternal cardiac function in fetal growth restriction","volume":"113","author":"Bamfo","year":"2006","journal-title":"BJOG"},{"key":"ref_56","unstructured":"Shams, P., Goyal, A., and Makaryus, A.N. (2026, May 06). Left Ventricular Ejection Fraction, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459131\/."},{"key":"ref_57","first-page":"QC01","article-title":"Maternal Cardiac Diastolic Dysfunction by Doppler Echocardiography in Women with Preeclampsia","volume":"10","author":"Muthyala","year":"2016","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1097\/HJH.0000000000002496","article-title":"Maternal myocardial dysfunction after normotensive fetal growth restriction compared with hypertensive pregnancies: A speckle-tracking study","volume":"38","author":"Orabona","year":"2020","journal-title":"J. Hypertens."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.jcmg.2017.11.017","article-title":"Assessment of Left Ventricular Function by Echocardiography","volume":"11","author":"Potter","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"102618","DOI":"10.1016\/j.bpobgyn.2025.102618","article-title":"Maternal hemodynamics in early and late fetal growth restriction","volume":"101","author":"Vasapollo","year":"2025","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1007\/s10554-015-0694-y","article-title":"Maternal cardiac remodeling and dysfunction in preeclampsia: A three-dimensional speckle-tracking echocardiography study","volume":"31","author":"Cong","year":"2015","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/1471-0528.17956","article-title":"Cardiovascular Adaptation in Fetal Growth Restriction: A Longitudinal Study from Fetuses at Term to the First Year of Life","volume":"132","author":"Coutinho","year":"2025","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/ijgo.14602","article-title":"Assessment of fetal cardiac morphology and functional changes in early-onset and late-onset fetal growth restriction","volume":"161","author":"Oluklu","year":"2023","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1002\/uog.1095","article-title":"Abnormal maternal cardiac function precedes the clinical manifestation of fetal growth restriction","volume":"24","author":"Vasapollo","year":"2004","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1161\/HYPERTENSIONAHA.115.06667","article-title":"Maternal Cardiovascular Function in Normal Pregnancy: Evidence of Maladaptation to Chronic Volume Overload","volume":"67","author":"Melchiorre","year":"2016","journal-title":"Hypertension"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"89","DOI":"10.5830\/CVJA-2016-021","article-title":"Physiological changes in pregnancy","volume":"27","author":"Tolppanen","year":"2016","journal-title":"Cardiovasc. J. Afr."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1097\/HJH.0000000000002886","article-title":"Adaptation of left ventricular diastolic function to pregnancy: A systematic review and meta-analysis","volume":"39","author":"Spaanderman","year":"2021","journal-title":"J. Hypertens."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1253\/circj.CJ-19-0501","article-title":"Left Ventricular Diastolic Function During the Normal Peripartum Period","volume":"83","author":"Kimura","year":"2019","journal-title":"Circ. J."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1139\/cjpp-2024-0010","article-title":"Cardiac physiology and pathophysiology in pregnancy","volume":"102","author":"Rizi","year":"2024","journal-title":"Can. J. Physiol. Pharmacol."},{"key":"ref_70","first-page":"1","article-title":"Right ventricular function in pregnant women with or without preeclampsia","volume":"18","author":"Nassef","year":"2020","journal-title":"Al-Azhar Assiut Med. J."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Lees, C., Visser, G.H.A., and Hecher, K. (2018). Fetal Cardiac Function in Fetal Growth Restriction. Placental-Fetal Growth Restriction, Cambridge University Press.","DOI":"10.1017\/9781316181898"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.ajog.2019.12.003","article-title":"Maternal and fetal cardiovascular adaptations in preeclampsia and\/or fetal growth restriction","volume":"222","author":"Youssef","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.ajog.2021.11.1357","article-title":"Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: An evidence-based approach","volume":"226","author":"Lees","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1161\/HYPERTENSIONAHA.108.117358","article-title":"Early and Late Preeclampsia: Two Different Maternal Hemodynamic States in the Latent Phase of the Disease","volume":"52","author":"Valensise","year":"2008","journal-title":"Hypertension"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Alipova, G., Ablakimova, N., Tussupkaliyeva, K., Bermagambetova, S., Kosmuratova, S., Karimsakova, B., Gaiday, A., Gaiday, A., Dinets, A., and Tussupkaliyev, A. (2025). Prevention of Pre-Eclampsia: Modern Strategies and the Role of Early Screening. JCM, 14.","DOI":"10.3390\/jcm14092970"},{"key":"ref_76","first-page":"88","article-title":"Hemodynamic phenotypes in preeclampsia, improving therapeutic strategies: A Scoping review","volume":"17","year":"2026","journal-title":"Obstet. Gynecol. Int. J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"29","author":"Nagueh","year":"2016","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1002\/uog.27668","article-title":"Adverse perinatal outcomes are strongly associated with degree of abnormality in uterine artery Doppler pulsatility index","volume":"64","author":"Dockree","year":"2024","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"103238","DOI":"10.1016\/j.jogc.2026.103238","article-title":"Association Between Uterine Artery Doppler and Severe Preeclampsia in Pregnancies Complicated by Late Preterm Fetal Growth Restriction","volume":"48","author":"Kouba","year":"2026","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_80","first-page":"100841","article-title":"Maternal hemodynamic profile during pregnancy and in the post-partum in hypertensive disorders of pregnancy and fetal growth restriction","volume":"5","author":"Stampalija","year":"2022","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/uog.17365","article-title":"Descriptive analysis of different phenotypes of cardiac remodeling in fetal growth restriction","volume":"50","author":"Sitges","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"105669","DOI":"10.1016\/j.earlhumdev.2022.105669","article-title":"Preeclampsia: Maternal cardiovascular function and optimising outcomes","volume":"174","author":"Dennehy","year":"2022","journal-title":"Early Hum. Dev."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"96.e1","DOI":"10.1016\/j.ajog.2018.09.017","article-title":"Uterine and fetal placental Doppler indices are associated with maternal cardiovascular function","volume":"220","author":"Tay","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Ornaghi, S., Caricati, A., Di Martino, D.D., Mossa, M., Di Nicola, S., Invernizzi, F., Zullino, S., Clemenza, S., Barbati, V., and Tin\u00e8, G. (2022). Non-invasive Maternal Hemodynamic Assessment to Classify High-Risk Pregnancies Complicated by Fetal Growth Restriction. Front. Clin. Diabetes Healthc., 3.","DOI":"10.3389\/fcdhc.2022.851971"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"3830","DOI":"10.1080\/14767058.2019.1695771","article-title":"Hemodynamic guided treatment of hypertensive disorders in pregnancy: Is it time to change our mind?","volume":"34","author":"Vasapollo","year":"2021","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e023694","DOI":"10.1161\/JAHA.121.023694","article-title":"Phenotype-Directed Management of Hypertension in Pregnancy","volume":"11","author":"McLaughlin","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s00404-026-08316-3","article-title":"Hemodynamics-guided therapy for hypertensive disorders of pregnancy: A systematic review","volume":"313","author":"Loheit","year":"2026","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.1080\/14767058.2019.1678136","article-title":"Friendly help for clinical use of maternal hemodynamics","volume":"34","author":"Valensise","year":"2021","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"4462","DOI":"10.1093\/eurheartj\/ehaf193","article-title":"2025 ESC Guidelines for the management of cardiovascular disease and pregnancy","volume":"46","author":"Haugaa","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"102695","DOI":"10.1016\/j.cpcardiol.2024.102695","article-title":"Maternal-fetal dyad beyond the phenomenology of pregnancy: From primordial cardiovascular prevention on out, do not miss this boat!","volume":"49","author":"Bucciarelli","year":"2024","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"S\u0142awek-Szmyt, S., Kawka-Paciorkowska, K., Ciep\u0142ucha, A., Lesiak, M., and Ropacka-Lesiak, M. (2022). Preeclampsia and Fetal Growth Restriction as Risk Factors of Future Maternal Cardiovascular Disease\u2014A Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11206048"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Morales-Suarez-Varela, M., and Guillen-Grima, F. (2025). Cardiovascular Risk During Pregnancy: Scoping Review on the Clinical Implications and Long-Term Consequences. J. Clin. Med., 14.","DOI":"10.20944\/preprints202510.0198.v1"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"2641542","DOI":"10.1080\/10641963.2026.2641542","article-title":"Hypertensive disorders of pregnancy: A comprehensive review of pathophysiology, diagnosis, treatment, and long-term cardiovascular implications","volume":"48","author":"Fan","year":"2026","journal-title":"Clin. Exp. Hypertens."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1002\/uog.70123","article-title":"Fetal cardiac remodeling in second trimester in pregnancies with pre-eclampsia and\/or fetal growth restriction: Deep-learning-based approach using population-wide data","volume":"67","author":"Mikolaj","year":"2026","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Palmiero, P., Caretto, P., Ciccone, M.M., and Maiello, M. (2025). Long-Term Cardiovascular Risk and Maternal History of Pre-Eclampsia. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093121"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2414\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:39:34Z","timestamp":1785487174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":95,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16152414"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16152414","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]}}}