Lower Maternal Diastolic Blood Pressure Linked to Improved Fetal Brain Development in CHD: Study
USA: Lower maternal diastolic blood pressure was associated with better fetal brain maturation in pregnancies complicated by congenital heart disease (CHD), possibly by enhancing maternal–fetal circulatory coupling and improving fetal cerebral perfusion. These findings suggest maternal hemodynamics may influence fetal neurodevelopment in CHD and warrant further evaluation in interventional studies.
The findings, published in eBioMedicine, come from a study led by Siân Wilson and colleagues at the Fetal-Neonatal Neuroimaging & Developmental Science Centre, Boston Children’s Hospital, Boston, USA. The researchers investigated whether maternal blood pressure is associated with fetal cerebral blood flow and brain growth in pregnancies affected by congenital heart disease, a condition known to increase the risk of long-term neurodevelopmental difficulties.
For this purpose, the researchers combined a retrospective cohort with a prospective imaging study involving 1,374 pregnancies, including 494 with fetal CHD, 769 with other fetal anomalies, and 111 without fetal anomalies. Maternal blood pressure was evaluated alongside fetal brain MRI and Doppler ultrasound findings to assess its association with fetal cerebral blood flow, umbilical circulation, and cortical brain development.
Key Findings:
- Mothers carrying fetuses with congenital heart disease had a distinct maternal blood pressure profile compared with those carrying healthy fetuses or fetuses with non-cardiac anomalies.
- In CHD pregnancies, lower maternal diastolic blood pressure was associated with reduced fetal cerebrovascular resistance, indicating improved blood flow to the fetal brain.
- Lower maternal diastolic blood pressure was also linked to a lower cerebroplacental flow ratio, suggesting adaptive changes that help preserve fetal cerebral perfusion.
- Brain MRI showed that lower maternal diastolic blood pressure was associated with better cortical growth, with less impairment in the sensorimotor, frontal, and temporal brain regions.
- These associations were observed only in pregnancies complicated by CHD and were not seen in pregnancies without fetal anomalies.
- The observed relationship remained significant after adjusting for maternal medication use, placental pathology, estimated fetal weight, and cardiac physiology, supporting an independent association between maternal hemodynamics and fetal brain development.
The findings suggest that lower maternal diastolic blood pressure may reflect an adaptive maternal–fetal circulatory response that improves fetal brain perfusion, highlighting maternal cardiovascular physiology as a potentially modifiable factor influencing fetal neurodevelopment in CHD.
The study was limited by its single-center design, retrospective and secondary analyses, predominance of severe CHD cases, single-time-point blood pressure measurements, and observational nature, which precludes causal conclusions.
Overall, the findings link maternal cardiovascular physiology with fetal cerebral blood flow and cortical maturation in CHD, supporting further prospective and interventional studies to determine whether monitoring or modifying maternal blood pressure can improve fetal brain development.
Reference:
Wilson, S., Jeong, S., Wilkins-Haug, L., Grant, P. E., Rollins, C. K., Morton, S. U., & Im, K. (2026). Linking maternal blood pressure with fetal cerebral haemodynamics and cortical growth in congenital heart disease. EBioMedicine, 130, 106367. https://doi.org/10.1016/j.ebiom.2026.106367
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