Assessment of arterial function in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics

Foo, L.; McEniery, Carmel M.; Lees, C.; Khalil, Asma

doi:10.1002/uog.17565

Cited by 28 publications

(27 citation statements)

References 56 publications

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“…In recent years, adverse pregnancy outcomes (e.g., preterm birth, preeclampsia, gestational diabetes) have been related to greater carotid IMT [14,20,21], a non-invasive validated and reliable marker of subclinical vascular remodeling and damage [18] assessed by ultrasonography. Similarly, higher baPWV, a mixed measure of both central and peripheral arterial stiffness, has been linked to preeclampsia/gestational hypertension [22]. However, these studies have focused largely on European/Caucasian premenopausal women, and whether these associations persist in midlife has been understudied.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

et al. 2019

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We identified sex-specific factors associated with subclinical CVD measures in late midlife women. • Hypertension in pregnancy was related to midlife subclinical atherosclerosis. • History of gestational diabetes was associated with arterial stiffness in midlife. • Need to assess benefit of a composite subclinical CVD index for risk modification. A R T I C L E I N F O Keywords: Cardiovascular disease Midlife Reproductive history Subclinical atherosclerosis Women's health A B S T R A C TBackground and aims: Reproductive factors are associated with later life CVD in women (e.g., age at first birth, preeclampsia, gestational diabetes), but studies have focused largely on premenopausal women. We examined the relationship of reproductive factors with subclinical CVD burden in late midlife women. Methods: We included 964 parous women from the Study of Women's Health Across the Nation (SWAN), who completed a reproductive history questionnaire at the 13th SWAN visit (2011)(2012), and a carotid ultrasound and brachial-ankle pulse wave velocity (baPWV) assessment. The primary outcomes were carotid intima-media thickness, plaque, and baPWV; our secondary outcome was a composite subclinical CVD index created using these measures. Linear and logistic regression was performed to examine associations with individual subclinical CVD measures, and multinomial logistic regression was used in analyses of the composite index. Models adjusted for socio-demographics and cardiovascular risk factors. Results: Mean age at subclinical CVD assessment was 60.2 years (SD ± 2.7). History of gestational hypertension/preeclampsia was associated with greater carotid IMT (β: 0.038, p = 0.004). Earlier age at first birth was associated with subclinical CVD, but not when accounting for CVD risk factors. History of gestational diabetes was associated with greater baPWV, but not related to our composite index. Conclusions: Pregnancy history is an important marker of subclinical CVD in late midlife and may impact the vasculature through distinct pathways. Future studies are necessary to evaluate racial/ethnic differences in the observed associations and to assess the benefit of a composite subclinical CVD index for earlier CVD risk modification in midlife women.

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Section: Introductionmentioning

confidence: 99%

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

et al. 2019

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“…Both pulse wave velocity (PWV), which is a direct measure of arterial stiffness, and augmentation index (AIx), which is a surrogate measure of arterial stiffness, can be measured non‐invasively in pregnancy. We, and others, have demonstrated increased arterial stiffness, as assessed by PWV and AIx, before, during and after the clinical stage of pre‐eclampsia.…”

Section: Introductionmentioning

confidence: 51%

Effect of sildenafil on maternal hemodynamics in pregnancies complicated by severe early‐onset fetal growth restriction: planned subgroup analysis from a multicenter randomized placebo‐controlled double‐blind trial

Khalil

Sharp

Cornforth

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives Fetal growth restriction (FGR) is associated with maternal cardiovascular changes. Sildenafil, a phosphodiesterase type‐5 inhibitor, potentiates the actions of nitric oxide, and it has been suggested that it alters maternal hemodynamics, potentially improving placental perfusion. Recently, the Dutch STRIDER trial was stopped prematurely owing to excess neonatal mortality secondary to pulmonary hypertension. The main aim of this study was to investigate the effect of sildenafil on maternal hemodynamics in pregnancies with severe early‐onset FGR. Methods This was a cardiovascular substudy within a UK multicenter, placebo‐controlled trial, in which 135 women with a singleton pregnancy and severe early‐onset FGR (defined as a combination of estimated fetal weight or abdominal circumference below the 10th centile and absent/reversed end‐diastolic flow in the umbilical artery on Doppler velocimetry, diagnosed between 22 + 0 and 29 + 6 weeks' gestation) were assigned randomly to receive either 25 mg sildenafil three times daily or placebo until 32 + 0 weeks' gestation or delivery. Maternal blood pressure (BP), heart rate (HR), augmentation index, pulse wave velocity (PWV), cardiac output, stroke volume (SV) and total peripheral resistance were recorded before randomization, 1–2 h and 48–72 h post‐randomization, and 24–48 h postnatally. For continuous data, analysis was performed using repeated measures ANOVA methods including terms for timepoint, treatment allocation and their interaction. Results Included were 134 women assigned randomly to sildenafil (n = 69) or placebo (n = 65) who had maternal BP and HR recorded at baseline. At 1–2 h post‐randomization, compared with baseline values, sildenafil increased maternal HR by 4 bpm more than did placebo (mean difference, 5.00 bpm (95% CI, 1.00–12.00 bpm) vs 1.25 bpm (95% CI, –5.38 to 7.88 bpm); P = 0.004) and reduced systolic BP by 1 mmHg more (mean difference, –4.13 mmHg (95% CI, –9.94 to 1.44 mmHg) vs –2.75 mmHg (95% CI, –7.50 to 5.25 mmHg); P = 0.048). Even after adjusting for maternal mean arterial pressure, sildenafil reduced aortic PWV by 0.60 m/s more than did placebo (mean difference, –0.90 m/s (95% CI, –1.31 to –0.51 m/s) vs –0.26 m/s (95% CI, –0.75 to 0.59 m/s); P = 0.001). Sildenafil was associated with a non‐significantly greater decrease in SV index after 1–2 h post‐randomization than was placebo (mean difference, –5.50 mL/m2 (95% CI, –11.00 to –0.50 mL/m2) vs 0.00 mL/m2 (95% CI, –5.00 to 4.00 mL/m2); P = 0.056). Conclusions Sildenafil in a dose of 25 mg three times daily increases HR, reduces BP and reduces arterial stiffness in pregnancies complicated by severe early‐onset FGR. These changes are short term, modest and consistent with the anticipated vasodilatory effect. They have no short‐ or long‐term clinical impact on the mother. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…We read with great interest the recommendations of the International Working Group on Maternal Hemodynamics on techniques and devices for assessment of arterial function in pregnancy. There is growing interest in the involvement of maternal cardiovascular (CV) system in both complicated and uncomplicated pregnancies.…”

Section: Current Literature On Assessment Of Peripheral Arterial Tonomentioning

confidence: 99%

Assessment of arterial function in pregnancy: what about peripheral arterial tonometry?

Sciatti

Orabona

2018

Ultrasound in Obstet & Gyne

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Assessment of arterial function in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics

Cited by 28 publications

References 56 publications

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

Effect of sildenafil on maternal hemodynamics in pregnancies complicated by severe early‐onset fetal growth restriction: planned subgroup analysis from a multicenter randomized placebo‐controlled double‐blind trial

Assessment of arterial function in pregnancy: what about peripheral arterial tonometry?

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