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 (SBP_Ao) and arterial stiffness. The hypothesis is that increased SBP_Ao, 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 SBP_Ao 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 SBP_Ao. 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 SBP_Ao (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 SBP_Ao (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 SBP_Ao and arterial stiffness that is apparent from the first-trimester of pregnancy.