Name two risk factors for placental insufficiency or fetal growth restriction in the context of hypertensive disorders.

• A. Severe preeclampsia and chronic hypertension
• B. Chronic hypertension and smoking
• C. Severe preeclampsia and diabetes
• D. Smoking and obesity

Answer: (A)

Placental insufficiency and fetal growth restriction arise when the placenta cannot deliver enough oxygen and nutrients, often due to impaired uteroplacental blood flow from maternal vascular disease seen in hypertensive disorders. The two strongest risk factors in this context are chronic hypertension and severe preeclampsia.

Chronic hypertension reflects preexisting vascular changes that narrow and stiffen the uteroplacental vessels, reducing blood flow to the placenta even before pregnancy symptoms begin. This baseline restriction makes the placenta more susceptible to underperfusion and growth restriction as pregnancy progresses.

Severe preeclampsia represents a more intense placental pathology with marked endothelial dysfunction and abnormal remodeling of the spiral arteries. This leads to significant vasospasm and reduced placental perfusion, directly contributing to fetal growth restriction.

While other factors like smoking or obesity can contribute to growth restriction, they don't align as directly with the specific placental vascular pathology associated with hypertensive disorders as do chronic hypertension and severe preeclampsia.