Maternal cardiovascular adjustments to pregnancy

Metcalfe, James; Ueland, Kent

doi:10.1016/0033-0620(74)90028-0

Cited by 226 publications

(67 citation statements)

References 61 publications

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“…Metcalfe and Ueland . (12) found an increase of stroke volume and cardiac output with a peak at 20 weeks gestation, while other researchers reported this peak at 32 weeks (I). Some researchers found a gradual decrease in cardiac output towards term (18,20), while the results of others (II) failed to confirm this finding.…”

Section: Introductionmentioning

confidence: 89%

Cardiocirculatory adjustments during pregnancy — An echocardiographic study

Laird-Meeter

Ley

Bom

et al. 1979

Clinical Cardiology

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Summary: Adaptation of the circulation to pregnancy occurs via a complicated series of changes not yet completely understood. To define pertinent alterations, echocardiographic measurements of left ventricular function were performed every 4 weeks in 13 normal pregnant women. Six weeks postpartum each woman was reexamined; thus each woman served as her own nonpregnant control. Left ventricular dimensions, left ventricular wall thickness, shortening fraction, and rate of change of these measurements were recorded. As expected, cardiac output was increased throughout pregnancy. Up to 20 weeks gestation this occurred via an increased heart rate. After 20 weeks gestation stroke volume increased significantly, with 20% at 20-26 weeks up to 30% at term (p < O.OI). With the end-diastolic wall thickness remaining equal, myocardial hypertrophy occurred. This was corroborated by an increase in end-systolic left ventricular wall thickness towards term: from 13.8 mm (S.D. ± 1.73) in early pregnancy to 16.6 mm (S. D. ± 1.62) at term, with end-systolic left ventricular dimension unchanged. It was concluded that during pregnancy the mechanism to produce a higher cardiac output shifts from an increase in cardiac frequency to elevation of stroke volume with concomitant myocardial hypertrophy. Due to changes in heart rate and afterload, no conclusions could be drawn regarding myocardial contractility.

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Section: Introductionmentioning

confidence: 89%

Cardiocirculatory adjustments during pregnancy — An echocardiographic study

Laird-Meeter

Ley

Bom

et al. 1979

Clinical Cardiology

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“…8 Reduced aortic stiffness and increased endothelial prostacyclin and nitric oxide production may also be involved.…”

Section: Preeclampsia Superimposed On Chronic Hypertensionmentioning

confidence: 99%

Preeclampsia and Hypertensive Disease in Pregnancy: Their Contributions to Cardiovascular Risk

Valdiviezo

Garovic

Ouyang

2012

Clinical Cardiology

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More women than men die each year of cardiovascular disease, which remains the leading cause of death in the United States. Sex-specific factors, including pregnancy-related disorders, should be considered when assessing cardiovascular (CV) risk in women. Hypertensive disorders of pregnancy have been associated with CV risk later in life and may identify women in whom earlier primary prevention may reduce their risk. This article reviews the physiologic changes in blood pressure during pregnancy, current definitions of hypertensive diseases of pregnancy and preeclampsia, and postulated pathophysiologic mechanisms leading to preeclampsia that might contribute to later CV risk. Also summarized are studies providing evidence on the association between hypertensive diseases of pregnancy and future CV risk. IntroductionCardiovascular disease (CVD) continues to be the leading cause of death in the United States. More women than men die each year of heart disease. Despite efforts to improve prevention, diagnosis, and treatment of CVD over recent years that have resulted in an overall reduction of cardiovascular (CV) death rates, CVD death rates are on the rise for women age <55 years.1 This is in part due to genderrelated differences in risk factors, symptoms, and treatment. Traditional risk factors and risk-stratification tools fail to take sex-specific risk factors for women into consideration. Gestational hypertension, diabetes mellitus (DM), and preeclampsia-eclampsia may be associated with increased risk of CVD later in life. Identification of these higher-risk women would provide the opportunity for closer surveillance and preventive programs to reduce CV risk. This article reviews the physiologic changes in blood pressure (BP) during pregnancy, current definitions of hypertensive disease of pregnancy and preeclampsia, postulated pathophysiologic mechanisms leading to preeclampsia that might contribute to later CV risk, and the evidence on the association between hypertensive diseases of pregnancy and future CV risk.Two meta-analyses of the literature were published in 2007. 2,3 To provide current data on the association between

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“…It has been noted that blood volume, cardiac output and stroke volume begin to change after the first trimester to accommodate the growing fetus [19,20]. Systemic vascular resistance is also known to decrease in response to haemodynamic changes during pregnancy [21][22][23]. Thus, the increase in pulse pressure in the late pregnant women observed in this study is the normal haemodynamic change in the cardiovascular system during pregnancy.…”

Section: Discussionmentioning

confidence: 55%

“…The mechanism of increased nP2 of bilateral pulses in the late pregnant women is not well understood at present. The change in pulse waveform due to decreased systemic vascular resistance during pregnancy [21][22][23] might be one of the mechanisms of this phenomenon.…”

Section: Discussionmentioning

confidence: 99%