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Maternal haemodynamics at 11-13 weeks of gestation and adverse pregnancy outcomes
  1. A Khalil1,
  2. R Akolekar2,
  3. A Syngelaki1,2,
  4. M ElKhaouli1,2,
  5. K Nicolaides1,2
  1. 1Institute for Women's Health, University College London, London, United Kingdom
  2. 2King's College London, London, United Kingdom

Abstract

Objective Women who develop pre-eclampsia (PE) or gestational diabetes (GDM) are at increased risk of cardiovascular disease. In individuals with cardiovascular disorders there is increased central aortic systolic blood pressure (SBPAo) and arterial stiffness. The hypothesis is that increased SBPAo, and arterial stiffness are apparent before the clinical onset of adverse pregnancy outcomes.

Methods This was a prospective study in singleton pregnancies at 11+0-13+6 weeks' gestation. Pulse wave velocity (PWV), augmentation index (AIx) and SBPAo were measured. We compared these parameters in those that developed PE (n=181), GDM (n=105), gestational hypertension (n=137), small for gestational age (n=337) with unaffected controls (n=6,766). Multiple regression analysis was used to examine which of the maternal characteristics provided a significant contribution in the prediction of AIx-75, PWV and SBPAo. Each value was expressed as a multiple of the median (MoM) after adjustment for those characteristics.

Results In the PE group there was an increase in AIx-75 (1.13 vs 1.00 MoM, p<0.0001), PWV (1.11 vs 1.00 MoM, p<0.0001), and SBPAo (1.09 vs. 1.00 MoM, p<0.0001). In the GDM group there was an increase in PWV (1.06 MoM, IQR 0.96-1.19 MoM vs. 1.00 MoM, IQR 0.90-1.13 MoM, p=0.001) and SBPAo (1.03 MoM, IQR 0.98-1.14 vs. 1.00, IQR 0.94-1.08, p<0.0001), but no significant difference in the AIx (1.02 MoM, IQR 0.89-1.22 MoM vs. 1.00 MoM, IQR 0.87-1.17 MoM, p=0.118).

Conclusion A high proportion of women who develop PE or GDM have increased SBPAo and arterial stiffness that is apparent from the first-trimester of pregnancy.

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