BACKGROUND
Compared with gestational hypertension, preeclampsia has traditionally been considered
the worse end of the spectrum of hypertensive disorders of pregnancy. It is associated
with worse pregnancy outcomes and future cardiovascular morbidities. Both hypertensive
disorders may be associated with cardiac maladaptation in pregnancy. However, previous
studies were limited by small numbers and a paucity of longitudinal data and unaccounted
for the contribution of maternal characteristics that can affect hemodynamics.
OBJECTIVE
This study aimed to assess, in an unselected population, the maternal cardiac adaptation
in normotensive and hypertensive pregnancies after controlling for important maternal
characteristics that affect maternal cardiac function and the interaction among these
covariates.
STUDY DESIGN
This was a prospective, multicenter longitudinal study of maternal hemodynamics, assessed
by a noninvasive bioreactance technology, measured at 11 0/7 to 13 6/7, 19 0/7 to
24 0/7, 30 0/7 to 34 0/7, and 35 0/7 to 37 0/7 weeks of gestation in 3 groups of women.
Group 1 was composed of women with preeclampsia (n=45), group 2 was composed of women
with gestational hypertension (n=61), and group 3 was composed of normotensive women
(n=1643). A multilevel linear mixed-effects model was performed to compare the repeated
measures of hemodynamic variables controlling for maternal age, height, weight, weight
gain, race, previous obstetrical history, and birthweight.
RESULTS
After adjusting for confounders that significantly affect maternal hemodynamics, both
group 1 and group 2, compared with group 3, had pathologic cardiac adaptation. Group
1, compared with group 3, demonstrated hyperdynamic circulation with significantly
higher cardiac output driven by greater stroke volume in the first trimester of pregnancy.
As the pregnancies progressed to after 20 0/7 weeks of gestation, this hyperdynamic
state transitioned to hypodynamic state with low cardiac output and high peripheral
vascular resistance. Group 2, compared with group 3, had no significant differences
in cardiac output, stroke volume, and heart rate before 20 0/7 weeks of gestation
but thereafter demonstrated a continuous decline in cardiac output and stroke volume,
similar to group 1. Both groups 1 and 2, compared with group 3, had persistently elevated
mean arterial pressure and uterine artery pulsatility index throughout pregnancy.
CONCLUSION
After adjusting for confounders that affect maternal hemodynamics in an unselected
pregnant population, women with preeclampsia and gestational hypertension, compared
with normotensive women, demonstrated similar cardiac maladaptation. This pathologic
profile was evident after 20 0/7 weeks of gestation and at least 10 weeks before the
clinical manifestation of the disease.
Keywords
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Article info
Publication history
Published online: November 30, 2022
Accepted:
November 28,
2022
Received in revised form:
November 21,
2022
Received:
October 3,
2022
Footnotes
Research data are not shared.
The authors report no conflict of interest.
This study was supported by a grant from the Fetal Medicine Foundation (charity number 1037116).
Cite this article as: Ling HZ, Guy G, Nicolaides KH, et al. Longitudinal maternal cardiac function in hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
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