Screening for pre-eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non-obese patients

G Gagliardi; G M Tiralongo; D LoPresti; I Pisani; D Farsetti; B Vasapollo; G P Novelli; A Andreoli; H Valensise

doi:10.1002/uog.17379

Screening for pre-eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non-obese patients

Ultrasound Obstet Gynecol. 2017 Nov;50(5):584-588. doi: 10.1002/uog.17379.

Authors

G Gagliardi¹, G M Tiralongo^{1

2}, D LoPresti^{1

2}, I Pisani^{1

2}, D Farsetti^{1

2}, B Vasapollo¹, G P Novelli³, A Andreoli⁴, H Valensise^{1

2}

Affiliations

¹ Department of Obstetrics and Gynaecology, Casilino Hospital, Rome, Italy.
² Department of Biomedicine, Tor Vergata University, Rome, Italy.
³ Department of Cardiology, San Sebastiano Martire Hospital, Frascati, Italy.
⁴ Department of Physiology, Tor Vergata University, Rome, Italy.

PMID: 27925328
DOI: 10.1002/uog.17379

Abstract

Objective: To test if maternal hemodynamics and bioimpedance, assessed at the time of combined screening for PE, are able to identify in the first trimester of gestation normotensive non-obese patients at risk for pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR).

Methods: One hundred and fifty healthy nulliparous non-obese women (body mass index < 30 kg/m² ) in the first trimester of pregnancy underwent assessment by UltraSonic Cardiac Output Monitor (USCOM) to detect hemodynamic parameters, bioimpedance analysis to characterize body composition, and combined screening for PE (assessment of maternal history, biophysical and maternal biochemical markers). Patients were followed until term, noting the appearance of PE and/or IUGR.

Results: One hundred and thirty-eight patients had an uneventful pregnancy (controls), while 12 (8%) developed complications (cases). USCOM showed, in cases compared with controls, lower cardiac output (5.6 ± 0.3 vs 6.7 ± 1.1 L/min, P < 0.001), lower inotropy index (1.54 ± 0.38 vs 1.91 ± 0.32 W/m² , P < 0.001) and higher total vascular resistance (1279.8 ± 166.4 vs 1061.4 ± 179.5 dynes × s/cm⁵ , P < 0.001). Bioimpedance analysis showed, in cases compared with controls, lower total body water (53.7 ± 3.3% vs 57.2 ± 5.6%, P = 0.037). Combined screening was positive for PE in 8% of the controls and in 50% of the cases (P < 0.001). After identification of cut-off values for USCOM and bioimpedance parameters, forward multivariate logistic regression analysis identified as independent predictors of complications in pregnancy the inotropy index (derived by USCOM), fat mass (derived from bioimpedance analysis) and combined screening.

Conclusions: Combined screening for PE and assessment of bioimpedance and maternal hemodynamics can be used to identify early markers of impaired cardiovascular adaptation and body composition that may lead to complications in the third trimester of pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Keywords: bioimpedance; cardiac function; combined screening; first trimester; hemodynamics; pre-eclampsia.

MeSH terms

Adult
Biomarkers / analysis
Blood Pressure
Body Composition
Cardiac Output
Case-Control Studies
Electric Impedance*
Female
Hemodynamics / physiology*
Humans
Pre-Eclampsia / diagnosis*
Pregnancy
Pregnancy Trimester, First / physiology*
Ultrasonography, Prenatal / methods*
Vascular Resistance

Substances

Biomarkers