Fetal pulmonary vascular volume is impaired in mothers with early onset preeclampsia: a proof of concept study

Katinka Weller; Alex J. Eggink; Robbert J. Rottier; Irwin K.M. Reiss; Eric A.P. Steegers; Nina C.J. Peters

doi:10.1016/j.preghy.2026.101494

Fetal pulmonary vascular volume is impaired in mothers with early onset preeclampsia: a proof of concept study

Katinka Weller^*
, Alex J. Eggink
, Robbert J. Rottier
, Irwin K.M. Reiss
, Eric A.P. Steegers
, Nina C.J. Peters

^*Corresponding author for this work

University Medical Center Hamburg-Eppendorf

Research output: Contribution to journal › Article › Academic

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Abstract

Objectives:

Children of mothers with early-onset preeclampsia (EOPE) are at increased risk of respiratory morbidity due to factors including fetal growth restriction, prematurity, and impaired pulmonary vascular development. While animal studies suggest compromised fetal pulmonary vasculature in preeclampsia, human data remain limited. This study aimed to compare fetal pulmonary vascular volume in EOPE pregnancies with healthy controls as a proof of concept.

Study design and main outcome measures:

Pregnant women with EOPE and healthy controls were prospectively recruited. Ultrasound assessments were performed at three gestational intervals: 19 + 0–24 + 0 weeks (US1), 24 + 1–29 + 6 weeks (US2), and 30 + 0–32 + 0 weeks (US3). Using 3D Power Doppler ultrasound, fetal right pulmonary vascular volume (R-PVV), right lung volume (R-LV), and the R-PVV/LV ratio were measured. Perinatal parameters were also evaluated.

Results:

Seventy-two controls and 36 EOPE fetuses were included. EOPE fetuses showed significantly reduced R-PVV at US2 and US3 compared to controls. The R-PVV/LV ratio remained significantly lower at both time points, suggesting impaired vascular development independent of lung size. Maternal BMI, gestational age at birth, and neonatal outcomes differed significantly between groups.

Conclusions:

This is the first human study to demonstrate impaired fetal pulmonary vascular development in EOPE. These findings offer insight into the pathophysiological effects of EOPE on fetal lung health.

Original language	English
Article number	101494
Journal	Pregnancy Hypertension
Volume	45
DOIs	https://doi.org/10.1016/j.preghy.2026.101494
Publication status	Published - Sept 2026

Bibliographical note

Publisher Copyright:
© 2026 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Cite this

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title = "Fetal pulmonary vascular volume is impaired in mothers with early onset preeclampsia: a proof of concept study",

abstract = "Objectives:Children of mothers with early-onset preeclampsia (EOPE) are at increased risk of respiratory morbidity due to factors including fetal growth restriction, prematurity, and impaired pulmonary vascular development. While animal studies suggest compromised fetal pulmonary vasculature in preeclampsia, human data remain limited. This study aimed to compare fetal pulmonary vascular volume in EOPE pregnancies with healthy controls as a proof of concept. Study design and main outcome measures: Pregnant women with EOPE and healthy controls were prospectively recruited. Ultrasound assessments were performed at three gestational intervals: 19 + 0–24 + 0 weeks (US1), 24 + 1–29 + 6 weeks (US2), and 30 + 0–32 + 0 weeks (US3). Using 3D Power Doppler ultrasound, fetal right pulmonary vascular volume (R-PVV), right lung volume (R-LV), and the R-PVV/LV ratio were measured. Perinatal parameters were also evaluated. Results: Seventy-two controls and 36 EOPE fetuses were included. EOPE fetuses showed significantly reduced R-PVV at US2 and US3 compared to controls. The R-PVV/LV ratio remained significantly lower at both time points, suggesting impaired vascular development independent of lung size. Maternal BMI, gestational age at birth, and neonatal outcomes differed significantly between groups. Conclusions: This is the first human study to demonstrate impaired fetal pulmonary vascular development in EOPE. These findings offer insight into the pathophysiological effects of EOPE on fetal lung health.",

author = "Katinka Weller and Eggink, \{Alex J.\} and Rottier, \{Robbert J.\} and Reiss, \{Irwin K.M.\} and Steegers, \{Eric A.P.\} and Peters, \{Nina C.J.\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/",

year = "2026",

month = sep,

doi = "10.1016/j.preghy.2026.101494",

language = "English",

volume = "45",

journal = "Pregnancy Hypertension",

issn = "2210-7789",

publisher = "Elsevier",

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T1 - Fetal pulmonary vascular volume is impaired in mothers with early onset preeclampsia

T2 - a proof of concept study

AU - Weller, Katinka

AU - Eggink, Alex J.

AU - Rottier, Robbert J.

AU - Reiss, Irwin K.M.

AU - Steegers, Eric A.P.

AU - Peters, Nina C.J.

N1 - Publisher Copyright: © 2026 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/

PY - 2026/9

Y1 - 2026/9

N2 - Objectives:Children of mothers with early-onset preeclampsia (EOPE) are at increased risk of respiratory morbidity due to factors including fetal growth restriction, prematurity, and impaired pulmonary vascular development. While animal studies suggest compromised fetal pulmonary vasculature in preeclampsia, human data remain limited. This study aimed to compare fetal pulmonary vascular volume in EOPE pregnancies with healthy controls as a proof of concept. Study design and main outcome measures: Pregnant women with EOPE and healthy controls were prospectively recruited. Ultrasound assessments were performed at three gestational intervals: 19 + 0–24 + 0 weeks (US1), 24 + 1–29 + 6 weeks (US2), and 30 + 0–32 + 0 weeks (US3). Using 3D Power Doppler ultrasound, fetal right pulmonary vascular volume (R-PVV), right lung volume (R-LV), and the R-PVV/LV ratio were measured. Perinatal parameters were also evaluated. Results: Seventy-two controls and 36 EOPE fetuses were included. EOPE fetuses showed significantly reduced R-PVV at US2 and US3 compared to controls. The R-PVV/LV ratio remained significantly lower at both time points, suggesting impaired vascular development independent of lung size. Maternal BMI, gestational age at birth, and neonatal outcomes differed significantly between groups. Conclusions: This is the first human study to demonstrate impaired fetal pulmonary vascular development in EOPE. These findings offer insight into the pathophysiological effects of EOPE on fetal lung health.

AB - Objectives:Children of mothers with early-onset preeclampsia (EOPE) are at increased risk of respiratory morbidity due to factors including fetal growth restriction, prematurity, and impaired pulmonary vascular development. While animal studies suggest compromised fetal pulmonary vasculature in preeclampsia, human data remain limited. This study aimed to compare fetal pulmonary vascular volume in EOPE pregnancies with healthy controls as a proof of concept. Study design and main outcome measures: Pregnant women with EOPE and healthy controls were prospectively recruited. Ultrasound assessments were performed at three gestational intervals: 19 + 0–24 + 0 weeks (US1), 24 + 1–29 + 6 weeks (US2), and 30 + 0–32 + 0 weeks (US3). Using 3D Power Doppler ultrasound, fetal right pulmonary vascular volume (R-PVV), right lung volume (R-LV), and the R-PVV/LV ratio were measured. Perinatal parameters were also evaluated. Results: Seventy-two controls and 36 EOPE fetuses were included. EOPE fetuses showed significantly reduced R-PVV at US2 and US3 compared to controls. The R-PVV/LV ratio remained significantly lower at both time points, suggesting impaired vascular development independent of lung size. Maternal BMI, gestational age at birth, and neonatal outcomes differed significantly between groups. Conclusions: This is the first human study to demonstrate impaired fetal pulmonary vascular development in EOPE. These findings offer insight into the pathophysiological effects of EOPE on fetal lung health.

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DO - 10.1016/j.preghy.2026.101494

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SN - 2210-7789

VL - 45

JO - Pregnancy Hypertension

JF - Pregnancy Hypertension

M1 - 101494

ER -

Fetal pulmonary vascular volume is impaired in mothers with early onset preeclampsia: a proof of concept study

Abstract

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