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Modelling maternal cardiovascular adaptation to pregnancy: a scoping review

Kathryn Hunt, Yannis Polydoros, Raoul van Loon Orcid Logo, Rosemary C Townsend, Rebecca M Reynolds

BMC Pregnancy and Childbirth

Swansea University Authors: Yannis Polydoros, Raoul van Loon Orcid Logo

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DOI (Published version): 10.1186/s12884-025-08270-z

Abstract

Background: The maternal cardiovascular system undergoes a profound transformation during pregnancy. Disordered cardiovascular adaptation is associated with pre-eclampsia and fetal growth restriction; however, these complications remain challenging to predict and manage. Computational modelling pres...

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Published in: BMC Pregnancy and Childbirth
ISSN: 1471-2393
Published: Springer Nature 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa71108
Abstract: Background: The maternal cardiovascular system undergoes a profound transformation during pregnancy. Disordered cardiovascular adaptation is associated with pre-eclampsia and fetal growth restriction; however, these complications remain challenging to predict and manage. Computational modelling presents an opportunity to study the maternal circulation with unprecedented flexibility. We conducted a scoping review to assess the potential utility of computational models for studying maternal cardiovascular adaptation to pregnancy and providing insights into disease. We aimed to identify research gaps and barriers to translating this emerging field into clinical practice. Methods: Medline, Embase, and Web of Science Core Collection were searched from 01/01/2013 to 01/09/2025, for articles related to computational haemodynamic models of pregnancy. English-language studies describing models of the maternal circulation in human pregnancy were identified. Information on system modelled, study design, participant or clinical specimen details, and key findings were extracted from original research studies and presented in a narrative synthesis. Results: Of 662 citations, 37 met inclusion criteria, comprising 28 original research studies, two conference abstracts, and seven reviews. Amongst the original research studies, 27 were basic experimental papers and one was a retrospective cohort study. Nine experimental articles incorporated data from pregnant participants or clinical specimens into personalised models, with sample sizes between one and 21. Four of these included participants or specimens affected by hypertensive disorders of pregnancy or fetal growth restriction. The retrospective cohort study employed haemodynamic modelling to investigate blood loss in 480 patients with abnormally invasive placentas. Modelling approaches described included those simulating the entire maternal circulation, maternal cardiac remodelling, maternal renal autoregulation, the maternal pelvic circulation in isolation, uterine vascular adaptation, spiral artery remodelling, and blood flows within the placental intervillous space. Conclusions: Computational modelling could represent a powerful tool to advance understanding of maternal cardiovascular adaptation to pregnancy and guide future approaches to risk stratification, diagnosis, and management of pregnancy complications. Realising this promise will require cardiovascular models to be parameterised with scalable metrics, validated in large pregnancy cohorts, developed alongside robust computational processing pipelines, and integrated into existing clinical workflows. Protocol registration: The review protocol was registered prospectively with the Open Science Framework (osf.io/v3968).
Keywords: Pregnancy; Cardiovascular dysfunction; Computational modelling; Digital twins; Pre-eclampsia; Fetal growth restriction
College: Faculty of Science and Engineering
Funders: KH is funded by a British Heart Foundation Research Excellence Award (RE/18/5/34216). IP, RL, RT & RR receive funding from the Wellcome Leap In Utero program.

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