BACKGROUND
Maternal cardiovascular changes, occurring since the beginning of pregnancy, are necessary
for normal placentation and regular evolution of pregnancy.
OBJECTIVE
This study aimed to compare the hemodynamic profiles and cardiac remodeling of women
with hypertensive disorders of pregnancy and either appropriate for gestational age
fetuses or growth-restricted fetuses, women with normotensive pregnancies complicated
by fetal growth restriction, and women with uncomplicated pregnancies, during pregnancy
and the postpartum period.
STUDY DESIGN
A prospective longitudinal case–control design was used for this study. Over the study
period, 220 eligible women with singleton pregnancies were selected for the analysis
and divided into 4 groups: (1) hypertensive disorders of pregnancy with appropriate
for gestational age fetuses; (2) hypertensive disorders of pregnancy with fetal growth
restriction; (3) normotensive fetal growth restriction; and (4) controls. Ultrasound
fetal biometry and fetoplacental Doppler velocimetry were performed at recruitment.
Maternal hemodynamic assessment using transthoracic echocardiography was performed
at the time of recruitment by a dedicated cardiologist blinded to maternal clinical
data. The same assessments were performed in 104 patients at 32 weeks (interquartile
range, 24–40) after delivery by the same cardiologist.
RESULTS
During pregnancy, women in the hypertensive-disorders-of-pregnancy–fetal-growth-restriction
group showed significantly lower cardiac output and increased compared with those
in the control group. These values were associated with concentric remodeling of the
left ventricle owing to relatively increased wall thickness, which was not accompanied
by an increase in left ventricular mass. Isolated fetal growth restriction presented
similar but less important hemodynamic changes; however, there was no change in relative
wall thickness. At postpartum follow-up, the hemodynamic parameters of women in the
hypertensive-disorders-of-pregnancy–fetal-growth-restriction and isolated-fetal-growth-restriction
groups reverted to values similar to those of the control group. Only 8.3% of women
in these groups experienced hypertension even in the postpartum period, and asymptomatic
stage-B cardiac failure was observed for 17% at echocardiography. In the group of
women with hypertensive disorders of pregnancy and appropriate for gestational age
fetuses, cardiac output increased as in normal pregnancies, but total vascular resistance
was significantly higher; hypertension then occurred, along with ventricular concentric
hypertrophy and diastolic dysfunction. At postpartum follow-up, women in the hypertensive-disorders-of-pregnancy–appropriate-for-gestational-age-fetus
group showed significantly higher mean arterial pressure, total vascular resistance,
and left ventricular mass compared with those in the control group. Persistent hypertension
and asymptomatic stage-B cardiac failure were observed in 39.1% and 13% of women in
the former group, respectively.
CONCLUSION
Pregnancies with hypertensive disorders of pregnancy and fetal growth restriction
and normotensive pregnancies with fetal growth restriction were associated with the
hemodynamic profile of lower heart rate and cardiac output, most likely because of
abnormal adaptation to pregnancy, as confirmed by abnormal changes from pregnancy
to the postpartum period. The heart rates and cardiac output of women in the hypertensive-disorders-of-pregnancy–appropriate-for-gestational-age-fetus
group showed changes opposite to those observed in the hypertensive-disorders-of-pregnancy–fetal-growth-restriction
and fetal-growth-restriction groups. Obesity and other metabolic risk factors, significantly
prevalent in women in the hypertensive-disorders-of-pregnancy–appropriate-for-gestational-age-fetus
group, predispose to hypertension and cardiovascular diseases during pregnancy and
the postpartum period, potentially offering a window for personalized prevention.
Such preventive strategies could differ in women with hypertensive disorders of pregnancy
and fetal growth restriction characterized by poor early placental development.
Key words
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Article info
Publication history
Published online: December 20, 2022
Accepted:
December 14,
2022
Received:
November 17,
2022
Footnotes
The authors report no conflict of interest.
Cite this article as: Di Martino DD, Stampalija T, Zullino S, et al. Maternal hemodynamic profile during pregnancy and the postpartum period in hypertensive disorders of pregnancy and fetal growth restriction. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
Identification
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Published by Elsevier Inc.
