Elevated Placental Resistance Linked to Childhood Growth Issues: JAMA

A new study published in the Journal of the American Medical Association revealed that increased placental vascular resistance was associated with a higher risk of childhood underweight and stunting, emphasizing the need for routine Doppler monitoring during prenatal care.

The study analyzed data from 52,660 mother–infant pairs with singleton births from May 2012 to October 2023. Using electronic medical records and Maternal and Child Health Information System data, this study tracked prenatal Doppler indices like pulsatility index, resistance index, and systolic-to-diastolic ratio, across 4 pregnancy periods: 21–24 weeks, 25–28 weeks, 29–32 weeks, and 33–36 weeks.

Placental vascular resistance was evaluated because elevated resistance limits oxygen and nutrient delivery to the fetus, associated with adverse birth outcomes like fetal growth restriction. However, the study notes that its potential consequences on postnatal growth have been unclear until now.

Despite generally healthy birth measurements among the cohort, the average maternal age was 30 years, and 53% of infants were male. By age two, 0.2% of children were underweight, 0.3% were stunted, and 0.8% experienced wasting.

The most notable associations emerged during the 21–24-week gestational window, where elevated placental vascular resistance was strongly connected to later childhood underweight and stunting. The study reported that a higher resistance index during this period was associated with a 27% increased risk of underweight.

Similarly, higher pulsatility index, resistance index, and systolic-to-diastolic ratio corresponded to increased odds of stunting, with risk levels ranging from 19% to 52% depending on the specific measure.

This study examined growth patterns using a multi-trajectory model that grouped children based on linked length-for-age and weight-for-age trends. These patterns included categories such as persistently low, early-low with catch-up, below average, average, and persistently high.

Children exposed to higher vascular resistance across all 4 gestational periods showed an increased chance of being in the persistently low, early-low with catch-up, or below-average growth groups rather than maintaining typical growth. They also had substantially lower odds of falling into the persistently high growth group, suggesting that compromised placental blood flow can have sustained impacts on developmental trajectory. Overall, these findings highlight the importance of routine monitoring of umbilical artery Doppler indices during prenatal care.

Source:

Xu, L., Zhang, J., Chen, K., Dong, X., Qin, X., Huang, M., Kong, D., Fan, X., Mu, X., Hu, L., Wang, Y., Xia, Z., Li, J., Zhou, A., & Xiong, C. (2025). Placental vascular resistance and offspring growth from birth to age 2 years. JAMA Network Open, 8(11), e2543365. https://doi.org/10.1001/jamanetworkopen.2025.43365