Fetal growth restriction is one of the major contributors to perinatal morbidity and mortality. Women with pregnancy complicated by fetal growth restriction present haemodynamic alterations, particularly in case of early FGR associated or not associated with hypertension. These women present a hypovolemic state and hypodynamic circulation, that is, a low cardiac output and low plasma volume associated with uterine artery high vascular resistance, indicating reduced placental perfusion. These changes are also present in the pre-clinical stage, before trophoblast development and, as some studies suggest, in the preconception period. The proposed trigger is inadequate plasma expansion adaptation early in pregnancy. Late fetal growth restriction is not caused by placental insufficiency but rather by abnormal villous maturation and later in gestation placental dysfunction. Women with late fetal growth restriction show milder cardiovascular maladaptation compared to women with early fetal growth restriction. In these women, there might be subtle pre-existing maternal cardiovascular dysfunctions that become evident later in gestation due to increasing feto-placental demands. The knowledge of pathophysiological mechanisms that are behind early and late fetal growth restriction opens a window of possibilities for prediction, prevention, and therapy. In this chapter, we will discuss the latest evidence regarding maternal haemodynamic assessment and fetal growth restriction.