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Ultrasound Obstet Gynecol. 2012 Jul;40(1):28-34. doi: 10.1002/uog.11183. Epub 2012 Jun 18.

Maternal hemodynamics at 11-13 weeks' gestation and risk of pre-eclampsia.

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  • 1Department of Fetal Medicine, Institute for Women's Health, University College London Hospitals, London, UK. asmakhalil79@googlemail.com

Abstract

OBJECTIVE:

Women who develop pre-eclampsia are at increased risk of cardiovascular disease and stroke in the subsequent decades. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBP(Ao) ) and arterial stiffness, as assessed by pulse wave velocity (PWV) and augmentation index (AIx). The aim of this study was to examine the potential value of assessment of SBP(Ao) , PWV and AIx at 11-13 weeks' gestation in identifying women who subsequently develop pre-eclampsia.

METHODS:

This was a screening study for pre-eclampsia in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Maternal history and characteristics were recorded and PWV, AIx (adjusted to a heart rate of 75 beats per min (AIx-75)) and SBP(Ao) measured. We compared these parameters in women who developed pre-eclampsia (n = 181) with those in unaffected controls (n = 6766) and examined their performance in screening for pre-eclampsia.

RESULTS:

In the pre-eclampsia group, compared to unaffected controls, there was an increase in AIx-75 (1.13 vs. 1.00 multiples of the median (MoM); P < 0.0001), PWV (1.06 vs. 1.00 MoM; P < 0.0001) and SBP(Ao) (1.09 vs. 1.00 MoM; P < 0.0001). In screening for pre-eclampsia by a combination of maternal variables and log(10) AIx-75 MoM, log(10) PWV MoM and log(10) SBP(Ao) MoM, the estimated detection rate was 56.9% at a false-positive rate of 10%.

CONCLUSION:

Compared with women who remain normotensive, women who develop pre-eclampsia have higher SBP(Ao) and arterial stiffness, which is apparent from the first trimester of pregnancy.

Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

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