The effect of maternal hemodynamics on fetal growth in hypertensive pregnancies

Easterling, Thomas R.; Benedetti, Thomas J.; Carlson, Karen C.; Brateng, Debra; Wilson, Judy; Schmucker, Barbara

doi:10.1016/0002-9378(91)90436-u

Cited by 69 publications

(56 citation statements)

References 12 publications

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“…Our series, instead, mainly showed early PE with a BMI of 24 kg/m 2 often associated to FGR, the latest characterized by a hypovolemic state 18,20,28 with high TVR and low CO. 18,20,29 In the past, similar results on hypertensive patients with high TVR and lower birthweight were found by Easterling et al 30 We may hypothesize that Bosio's 12 and Easterling's 13 series and our previous studies 9 -11 were describing two different disease entities: one determined by maternal factors (late PE), and the other of placental origin (early PE).…”

Section: Prepregnancy Bmisupporting

confidence: 75%

Early and Late Preeclampsia

Valensise¹,

Vasapollo²,

Gagliardi³

et al. 2008

Hypertension

497

224

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Abstract-Because early and late preeclampsia (PE) are thought to be different disease entities, we compared maternal cardiac function at 24 weeks gestation in a group of normotensive asymptomatic patients with subsequent development of early (Ͻ34 weeks gestation) and late (Ն34 weeks gestation) PE (blood pressure Ͼ140/90ϩproteinuria Ͼ300 mg/dL) to detect possible early differences in the hemodynamic state. ; PϽ0.001). Early and late PE appear to develop from different hemodynamic states. Late PE appears to be more frequent in patients with high body mass index and low total vascular resistance; earlier forms of PE appear to be more frequent in patients with lower BMI and with bilateral notching of the uterine artery. These findings support the hypothesis of different hemodynamics and origins for early PE (placental mediated, linked to defective trophoblast invasion with high percentage of altered uterine artery Doppler) and late PE (linked to constitutional factors such as high body mass index). Key Words: preeclampsia/pregnancy Ⅲ hemodynamcs Ⅲ echocardiography P reeclampsia (PE) is associated with maternal perinatal morbidity and mortality 1 and affects 5% to 7% of pregnant patients worldwide. 2 Hemodynamic investigations during the latent phase of PE are scarce and conflicting because of the different classifications 3,4 used in the definition: mild, moderate, and severe, as well as early and late. The concept of early and late PE is more modern, and it is widely accepted that these two entities have different etiologies and should be regarded as different forms of the disease. 3,4 Early-onset PE (before 34 weeks) is commonly associated with abnormal uterine artery Doppler, fetal growth restriction (FGR), and adverse maternal and neonatal outcomes. 1,5 In contrast, late-onset PE (after 34 weeks) is mostly associated with normal or slight increased uterine resistance index, a low rate of fetal involvement, and more favorable perinatal outcomes. 5,6 Early-onset PE and FGR are placenta-mediated diseases that share important similarities as recently demonstrated by Crispi et al, 7,8 who reported placental growth factor (PIGF) as a useful second-trimester screening test for this form of the disease, but not for late-onset PE/FGR. Maternal echocardiography might identify at 24 weeks gestation patients who subsequently develop early severe maternal and fetal complications through the assessment of maternal hemodynamics and left ventricular geometry (elevated maternal total vascular resistance [TVR] and the presence of concentric geometry) 9 -11 suggesting an involvement of the whole cardiovascular system in the placental mediated disorder. Previous data published by Bosio 12 and Easterling 13 on the latent phase of PE are in contrast with this model (describing low TVR and high cardiac output [CO]), although the patients from those series developed late forms of PE.Interestingly, hemodynamics and volume homeostasis in women with previous PE appear to be similar to hypertensive subjects and different from healthy paro...

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Section: Prepregnancy Bmisupporting

confidence: 75%

Early and Late Preeclampsia

Valensise¹,

Vasapollo²,

Gagliardi³

et al. 2008

Hypertension

497

224

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“…As suggested by Easterling [41,42], PIH patients move from a hyper-dynamic low-resistance state to a state of high resistance when fetal growth is compromised. The first stage may be reflected by an increase in the circadian amplitude of systolic BP, whereas the second stage may be associated with a decrease in the circadian amplitude of systolic BP.…”

Section: Discussionmentioning

confidence: 99%

Circadian rhythm of maternal blood pressure and fetal growth

Maggioni¹,

Cornelissen²,

Otsuka³

et al. 2005

Biomedicine & Pharmacotherapy

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This study aimed at examining any relation between the circadian variation in blood pressure (BP) in human pregnancy and fetal growth. A prospective study included 52 pregnant women monitored during the third trimester of pregnancy. There were 33 uncomplicated pregnancies with normal fetal growth (Group 1) and 19 pregnancies complicated by intrauterine growth retardation (IUGR), confirmed at birth (Group 2). Ten women (five in each group) had pregnancy-induced hypertension. All women were hospitalized and followed a similar daily routine. BP was recorded with an automatic wearable device. Measurements were obtained every 20 min for 24 ± 1 h. BP profiles were analyzed by conventional statistical methods and by cosinor, involving the least squares fit of cosine curves with an anticipated period (24 h) to the data. BP parameters, fetal outcome, demographic and obstetric characteristics were compared between the two groups. Logistic regression and multivariate analyses were used to assess factors putatively associated with fetal outcome. The circadian amplitude of diastolic BP was found to be larger in normotensive women with IUGR. As gauged by odds ratios (OR), the circadian amplitude of diastolic BP (OR = 1.7, 95% CI: 1.1-2.8; P = 0.03) and hematocrit (OR = 1.4, 95% CI: 1.0-1.9; P = 0.04) were the only variables positively and independently associated with IUGR. In the presence of maternal hypertension, the circadian amplitude of systolic BP was negatively associated with IUGR (OR = 0.7, 95% CI: 0.5-1.0; P = 0.03). A larger circadian variation in diastolic BP, rather than a difference in the mean value of systolic or diastolic BP, was found to be statistically significantly associated with IUGR. This study adds another condition in which the circadian BP amplitude constitutes a harbinger of elevated risk, apart from an association with a shortened lifespan in the absence or presence of malignant hypertension and with an increased risk of stroke and nephropathy reported earlier.

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“…In hypertensive women presenting prior to 28 weeks, those characterized by high resistance compared to those characterized by high cardiac output delivered babies weighing 1058g less (P=0.001), delivered 4 weeks earlier, (P=0.001) and with a lower percentile birthweight, (19 th vs 39 th , P=0.005). 26 High resistance represents a more advanced form of hypertension requiring earlier delivery and proportionately smaller babies.…”

Section: Impact Of Antihypertensive Therapy On Growthmentioning

confidence: 99%

Pharmacological management of hypertension in pregnancy

Easterling

2014

Seminars in Perinatology

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Hypertension in pregnancy remains a significant public health problem. Pharmacological management of blood pressure in pregnancy is impacted by changes in maternal drug disposition and by the pharmacodynamic effects of specific agents. This paper will review the impact of pregnancy on pathways of drug elimination and the associated clinical implications, the pharmacodynamic effects of specific drugs and classes of drugs in pregnancy, and the data to date on the impact of antihypertensive therapy on mothers and their fetuses.

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The effect of maternal hemodynamics on fetal growth in hypertensive pregnancies

Cited by 69 publications

References 12 publications

Early and Late Preeclampsia

Early and Late Preeclampsia

Circadian rhythm of maternal blood pressure and fetal growth

Pharmacological management of hypertension in pregnancy

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