Peripheral maternal haemodynamics across pregnancy in hypertensive disorders of pregnancy

Petra E Verburg; Claire T Roberts; Emma McBean; Mylene E Mulder; Shalem Leemaqz; Jan Jaap H M Erwich; Gus A Dekker

doi:10.1016/j.preghy.2019.02.006

Peripheral maternal haemodynamics across pregnancy in hypertensive disorders of pregnancy

Pregnancy Hypertens. 2019 Apr:16:89-96. doi: 10.1016/j.preghy.2019.02.006. Epub 2019 Feb 23.

Authors

Petra E Verburg¹, Claire T Roberts², Emma McBean², Mylene E Mulder³, Shalem Leemaqz², Jan Jaap H M Erwich⁴, Gus A Dekker⁵

Affiliations

¹ Robinson Research Institute, University of Adelaide, Adelaide, Australia; Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Adelaide Medical School, University of Adelaide, Adelaide, Australia. Electronic address: petra.verburg@adelaide.edu.au.
² Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.
³ Robinson Research Institute, University of Adelaide, Adelaide, Australia; Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Adelaide Medical School, University of Adelaide, Adelaide, Australia.
⁴ Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁵ Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth Vale, Australia.

PMID: 31056165
DOI: 10.1016/j.preghy.2019.02.006

Abstract

Objectives: Evaluating maternal haemodynamics across pregnancy in uncomplicated pregnancies and those complicated by hypertensive disorders of pregnancy (HDP).

Study design: Prospective cohort study from 2015 to 2018 of healthy, nulliparous, singleton-bearing women. Maternal haemodynamics assessed by Uscom BP+ at 9-16 and 32-36 weeks' gestation in pregnancies complicated by HDP [preeclampsia with severe (sPE n = 12) and without severe clinical features (nsPE n = 49), gestational hypertension (GH n = 25), transient gestational hypertension (TGH n = 33)] were compared to uncomplicated pregnancies (n = 286) using mixed-effects linear modelling.

Main outcome measures: Maternal haemodynamic adaptation in uncomplicated pregnancies and those complicated by HDP.

Results: Between the two measurements, haemodynamic adaptation in women with sPE and nsPE was significantly different compared to those with uncomplicated pregnancies. An additional increase was observed for peripheral systolic blood pressure [SBP; 14.3 mmHg, 8.6-20.1 (sPE)], peripheral diastolic blood pressure [DBP; 7.7 mmHg, 3.3-12.1 (sPE); 2.6 mmHg, 3.3-12.1 (nsPE)] peripheral mean arterial pressure [MAP; 10.6 mmHg, 5.8-15.5 (sPE); 3.4 mmHg, 0.8-6.0 (nsPE)], peripheral pulse pressure [PP; 6.6 mmHg, 2.1-11.1 (sPE)], central SBP [15.8 mmHg, 10.4-21.2 (sPE); 2.9 mmHg, 0.1-5.8 (nsPE)], central DBP [8.3 mmHg, 3.9-12.6 (sPE); 2.5 mmHg, 0.2-4.8 (nsPE), central MAP [10.8 mmHg, 6.4-15.2 (sPE); 2.6 mmHg, 0.3-5.0 (nsPE)] and central PP [7.6 mmHg, 3.9-11.3 (sPE)]. Augmentation index (AIx) decreased less (15.5%, 6.3-24.6 (sPE); 9.0%, 4.2-13.6 (nsPE)] compared to uncomplicated pregnancies. Haemodynamic adaptation across pregnancy in women with GH and TGH was not different from those with uncomplicated pregnancies.

Conclusion: Women who develop preeclampsia show an altered, while those who develop GH or TGH demonstrate a comparable haemodynamic adaptation compared to uncomplicated pregnancies. TGH is not a benign condition.

Keywords: Augmentation index; Blood pressure; Hypertensive disorders of pregnancy; Maternal haemodynamics.

MeSH terms

Adult
Blood Pressure
Case-Control Studies
Cohort Studies
Female
Hemodynamics
Humans
Hypertension, Pregnancy-Induced / physiopathology*
Pregnancy
Pregnancy Trimesters
Prenatal Care
Prospective Studies
Young Adult