3.1 PRE-PREGNANCY CARDIOVASCULAR RISK IN WOMEN WITH PREVIOUS PREECLAMPSIA (PET)/INTRAUTERINE GROWTH RESTRICTION (IUGR)
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Women with history of preeclampsia (PET) and delivery of intrauterine growth restriction (IUGR) babies are at increased risk of cardiovascular events later in life. This could be related to endothelial dysfunction, altered arterial stiffness or metabolic abnormalities resulting from pregnancy complications. Alternatively, pre-existing abnormalities in the cardiovascular system may predispose them to both pregnancy related complications and cardiovascular disease later in life. We compared pre-pregnancy arterial stiffness and central haemodynamics between women with previous PET/IUGR and those with previous uncomplicated pregnancies.
Method: 46 women planning to conceive were prospectively recruited in two groups: (1) 34 parous women with previous normal pregnancies (controls) (2) 12 women with previous PET (ISSHP guideline) requiring delivery at <34 weeks or requiring treatment for severe preeclampsia and/or who delivered an IUGR baby. Brachial and central blood pressures, pulse wave analysis (AIx), carotid-femoral pulse wave velocity (a PWV) and cardiac output were assessed along with routine biochemistry.
Results: Women with previous PET/IUGR had higher brachial diastolic blood pressure (P=0.03), central systolic blood pressure (P=0.02), MAP (P=0.01), and PVR (P=0.03) compared to controls but had lower PP amplification (P=0.04). There was no difference in the adjusted AIx, aPWV or in the cholesterol/lipid profile between the groups.
Conclusion: Vascular dysfunction as reflected by higher central blood pressure and peripheral resistance exists pre-pregnancy in women with previous PET/IUGR compared to normal healthy women. Further prospective pre-pregnancy studies prior to development of PET/IUGR are needed to assess the mechanism of the vascular dysfunction that persists following these pregnancy complications.
| Cardiovascular parameter | Previous normal pregnancies (n=34) | Previous PET/IUGR (n=12) | P* |
|---|---|---|---|
| Age (yrs) | 37 ± 4 | 34 ± 5 | 0.07 |
| Brachial SBP (mm Hg) | 108 ± 8 | 114 ± 9 | 0.07 |
| Brachial DBP (mm Hg) | 71 ± 7 | 77 ± 8 | 0.03* |
| Brachial PP (mm Hg) | 37 ± 6 | 37 ± 4 | 0.7 |
| Central SBP (mm Hg) | 100 ± 9 | 107 ± 9 | 0.02* |
| PP (mm Hg) | 28 ± 5 | 29 ± 5 | 0.4 |
| PP amplification | 1.4 ± 0.1 | 1.3 ± 0.1 | 0.04* |
| MAP (mm Hg) | 84 ± 9 | 92 ± 9 | 0.01* |
| Heart rate (beats/min) | 67 ± 9 | 67 ± 13 | 0.9 |
| CO (L/min) | 5.5 ± 1.0 | 5.1 ± 1.1 | 0.3 |
| SV (ml) | 77 ± 13 | 64 ± 25 | 0.1 |
| PVR (dynes.s−1.cm−5) | 1258 ± 239 | 1508 ± 334 | 0.03* |
| AIXa (%) | 23 ± 6 | 27 ± 7 | 0.06 |
| aPWVb (m/sec) | 5.4 ± 0.1 | 5.5 ± 0.2 | 0.8 |
Data are means ± S.D. a=adjusted for age, height and heart rate. b=adjusted for MAP.
P <0.05 is statistically significant. (SBP= Systolic blood pressure, DBP= Diastolic blood pressure, PP= pulse pressure, MAP=Mean arterial pressure, CO=cardiac output, SV= stroke volume, PVR= peripheral vascular resistance)
Pre-pregnancy haemodynamics in two groups:
Differences of mean PVR in the two groups (P=0.03)
Cite this article
TY - JOUR AU - A.A. Mahendru AU - C.C. Lees AU - T.R. Everett AU - C.M. McEniery AU - I.B. Wilkinson PY - 2011 DA - 2011/11/29 TI - 3.1 PRE-PREGNANCY CARDIOVASCULAR RISK IN WOMEN WITH PREVIOUS PREECLAMPSIA (PET)/INTRAUTERINE GROWTH RESTRICTION (IUGR) JO - Artery Research SP - 140 EP - 140 VL - 5 IS - 4 SN - 1876-4401 UR - https://doi.org/10.1016/j.artres.2011.10.213 DO - 10.1016/j.artres.2011.10.213 ID - Mahendru2011 ER -