Maternal hemodynamics at 11–13 weeks' gestation and risk of pre‐eclampsia

Khalil, Asma; Akolekar, Ranjit; Syngelaki, Argyro; Elkhouli, M.; Nicolaides, Kypros H.

doi:10.1002/uog.11183

Cited by 77 publications

(69 citation statements)

References 34 publications

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“…In this study, we found that heart rate-corrected augmentation index (Alx@75) was higher in pre-eclampsia compared to that in normotensive pregnancy, indicating arterial stiffness. Similar results have been reported by others 41-45…”

Section: Discussionsupporting

confidence: 93%

Endothelial dysfunction and arterial stiffness in pre-eclampsia demonstrated by the EndoPAT method

Meeme¹,

Ga²,

Mammen³

et al. 2017

CVJA

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SummaryObjectivesThe EndoPAT method has been used as a noninvasive method for assessing endothelial function in several non-pregnant populations. We investigated its possible use in assessing endothelial dysfunction in pre-eclampsia.MethodsTwo hundred and fifteen participants were recruited and grouped as pre-eclamptic cases (105) and normotensive controls (110). Endothelial function and arterial stiffness were measured as reactive hyperaemia index and augmentation index, respectively, using the EndoPAT 2000 machine.ResultsThe reactive hyperaemia index was significantly lower in the pre-eclamptic group compared to the normotensive group (p < 0.05). Augmentation index on the other hand was significantly higher in the pre-eclamptic group compared to the normotensive group (p < 0.0001).ConclusionThe EndoPAT method demonstrates endothelial dysfunction and arterial stiffness in pre-eclampsia.

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Section: Discussionsupporting

confidence: 93%

Endothelial dysfunction and arterial stiffness in pre-eclampsia demonstrated by the EndoPAT method

Meeme¹,

Ga²,

Mammen³

et al. 2017

CVJA

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“…AIx75 and PWV readings, for example, have provided evidence of arterial stiffness at the 11-to 13-week mark in women who subsequently develop preeclampsia. 64 In addition, results of one study found that PWA measured between 11(+0) and 13(+6) weeks of gestation was able to predict 79% of women who developed preeclampsia and 88% of women who developed severe early-onset preeclampsia, with a falsepositive rate of 11%. 65 PWV may be especially useful for predicting preeclampsia in high-risk women.…”

Section: Preeclamptic Pregnancymentioning

confidence: 99%

Preeclampsia and Vascular Function: A Window to Future Cardiovascular Disease Risk

Enkhmaa

Wall

Mehta

et al. 2016

Journal of Women's Health

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Preeclampsia affects *3%-7% of all pregnancies and is the third leading cause of maternal mortality globally. Growing evidence indicates that preeclampsia results from vascular dysfunction, which also increases the risk for future cardiovascular events. Until recently, preeclampsia was considered a disorder limited to pregnancy, which fully resolved with the delivery of the placenta; however, it is now clear that women with a history of preeclampsia have approximately double the risk of future cardiovascular events compared to women with normotensive pregnancies. The aims of this review were to describe the hemodynamic and vascular changes that occur in normal and preeclamptic pregnancies, to review noninvasive methods to test vascular function, and to discuss the associated increased cardiovascular disease risk related to preeclampsia.

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“…Several studies show increased PWV after clinical onset of PE (19–21). More recently, women destined to develop preeclampsia have been shown to have increased PWV as compared to normal pregnancies as early as 11 to 13 weeks gestation (22, 23). Our laboratory has previously reported decreased arterial compliance prior to pregnancy, manifested by increased pulse pressure and pulse wave velocity, in patients who later develop preeclampsia (24).…”

Section: Commentmentioning

confidence: 99%

Pregnancy induces persistent changes in vascular compliance in primiparous women

Morris¹,

Hale²,

Badger³

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective Pregnancy induces rapid, progressive and substantial changes to the cardiovascular system. The low recurrence risk of preeclampsia, despite familial predisposition, suggests an adaptation associated with pregnancy that attenuates risk for subsequent preeclampsia. We aimed to evaluate the persistent effect of pregnancy on maternal cardiovascular physiology. Study Design Forty-five healthy nulliparous women underwent baseline cardiovascular assessment preconception and repeated an average of 30 months later. After baseline evaluation, 17 women (Preg) conceived singleton pregnancies and all delivered at term. The remaining 28 women comprised the non-pregnant control group (NP). We measured mean arterial blood pressure (MAP), cardiac output (CO), plasma volume (PV), pulse wave velocity (PWV), uterine blood flow (UBF), and flow-mediated vasodilation (FMD) at each visit. Results There was a significant decrease in mean arterial pressure from the prepregnancy visit to postpartum in women with an interval pregnancy (prepregnancy: 85.3±1.8, postpartum: 80.5±1.8 mm Hg), with no change in NP subjects (visit 1: 80.3±1.4, visit 2: 82.8±1.4 mm Hg), (p = .002). Pulse wave velocity was significantly decreased in women with an interval pregnancy (prepregnancy: 2.73±0.05, postpartum: 2.49±0.05 m/s), as compared to those without an interval pregnancy (visit 1: 2.56±0.04, visit 2: 2.50±0.04 m/s), (p = .005). We did not observe a residual effect of pregnancy on cardiac output, plasma volume, uterine blood flow or flow-mediated vasodilation. Conclusion Our observations of decreased mean arterial pressure and reduced arterial stiffness following pregnancy suggest a significant favorable effect of pregnancy on maternal cardiovascular remodeling. These findings may represent a mechanism by which preeclampsia risk is reduced in subsequent pregnancies.

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Maternal hemodynamics at 11–13 weeks' gestation and risk of pre‐eclampsia

Abstract: ABSTRACT

Cited by 77 publications

References 34 publications

Endothelial dysfunction and arterial stiffness in pre-eclampsia demonstrated by the EndoPAT method

Endothelial dysfunction and arterial stiffness in pre-eclampsia demonstrated by the EndoPAT method

Preeclampsia and Vascular Function: A Window to Future Cardiovascular Disease Risk

Pregnancy induces persistent changes in vascular compliance in primiparous women

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