Maternal arterial stiffness in hypertensive pregnancies with and without small‐for‐gestational‐age neonate

Abstract

Objective Pregnancies complicated by pre‐eclampsia with a small‐for‐gestational‐age (SGA) neonate have poorer maternal hemodynamic function compared to those with hypertensive disorders of pregnancy (HDP) and an appropriately grown neonate. Arterial stiffness is a recognized prognostic marker of cardiovascular disease in the general population. The aim of this study was to compare maternal arterial stiffness between hypertensive pregnancies with, and those without, a SGA neonate and normotensive control pregnancies. Methods This was a prospective cohort study of pregnancies complicated by pre‐eclampsia or gestational hypertension and healthy normotensive control pregnancies, presenting to a tertiary referral hospital between January 2012 and May 2018. Maternal arterial stiffness was assessed by aortic pulse‐wave velocity (PWV) and aortic augmentation index (AIx), which were recorded using a non‐invasive device (Arteriograph®). Maternal and hemodynamic factors were adjusted for using linear regression analysis. Pregnancies with HDP were divided into those that delivered a SGA (birth weight < 10th percentile) neonate (HDP + SGA group) and those that delivered an appropriately grown neonate (HDP‐only group). Comparisons between groups were carried out using the Mann–Whitney U‐test for continuous variables and the chi‐square (or Fisher's exact) test for categorical variables. Results Included in the analysis were 69 patients with HDP who delivered a SGA neonate, 129 with HDP who delivered a normally grown neonate and 220 healthy controls. Maternal age, weight, height and heart rate were associated significantly with brachial and aortic AIx. Maternal weight, height, mean arterial pressure, heart rate and gestational age were significant predictors of aortic PWV. Adjusted aortic AIx was significantly higher in both the HDP + SGA and HDP‐only groups, compared with in controls (12.5% and 10.0% vs 7.6%; both P < 0.01), and was significantly different between the two HDP groups (P = 0.002). Adjusted PWV was significantly higher in the HDP‐only group compared with in controls and the HDP + SGA group (7.7 m/s vs 7.1 m/s and 7.1 m/s; both P < 0.001). Conversely, unadjusted PWV was not significantly different between the two HDP groups (P = 0.414). Conclusions Pregnancies complicated by HDP with, and those without, a SGA neonate have significantly higher aortic AIx compared with uncomplicated normotensive pregnancies. Aortic AIx was highest in those pregnancies complicated by HDP with a SGA neonate, reflecting a progression in severity of arterial stiffness abnormality with a worsening clinical picture. These findings most likely reflect systemic reduced vascular compliance and increased systemic vascular resistance in pregnancy complicated by HDP. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…The prevailing hypothesis is that the latter occurs secondary to maternal cardiovascular dysfunction in the face of increased pregnancy hemodynamic demands with advancing gestation [3][4][5][6][7][8][9][10] . Subsequent placental hypoperfusion leading to placental dysfunction may manifest as HDP or SGA birth [11][12][13] . Some researchers have suggested that cardiovascular profiling might facilitate the screening, diagnosis and management of placental disorders.…”

“…The prevailing hypothesis is that the latter occurs secondary to maternal cardiovascular dysfunction in the face of increased pregnancy hemodynamic demands with advancing gestation 3–10 . Subsequent placental hypoperfusion leading to placental dysfunction may manifest as HDP or SGA birth 11–13 .…”