Maternal haemodynamic function differs in pre-eclampsia when it is associated with a small-for-gestational-age...

Area of Science:

• Obstetrics and Gynecology
• Cardiovascular Physiology
• Perinatal Medicine

Background:

• Gestational hypertension (GH) is a common complication of pregnancy.
• Fetal growth restriction, specifically small-for-gestational-age (SGA) babies, is often associated with adverse pregnancy outcomes.
• Understanding maternal hemodynamic differences in GH with and without SGA is crucial for risk stratification and management.

Purpose of the Study:

• To delineate maternal hemodynamic profiles in pregnancies complicated by gestational hypertension with small-for-gestational-age babies (HDP + SGA).
• To compare these profiles with gestational hypertension in appropriate-for-gestational-age babies (HDP-only) and normotensive pregnancies.
• To elucidate the role of maternal cardiovascular adaptation in the pathophysiology of hypertensive disorders of pregnancy.

Main Methods:

• A prospective cohort study was conducted involving women with HDP + SGA, HDP-only, and control pregnancies.
• Maternal hemodynamic indices, including cardiac output, stroke volume, and systemic vascular resistance, were measured non-invasively using an Ultrasound Cardiac Output Monitor (USCOM-1A®).
• Data were corrected for gestational age and maternal characteristics using device-specific reference ranges.

Main Results:

• Pregnancies with HDP + SGA exhibited significantly lower heart rates, cardiac output, and higher systemic vascular resistance compared to both control and HDP-only groups.
• No significant difference in mean arterial blood pressure was observed between the two HDP groups at presentation.
• Even HDP-only pregnancies showed impaired hemodynamic indices compared to normal pregnancies.

Conclusions:

• Women with HDP + SGA present with more pronounced hemodynamic dysfunction than those with HDP-only.
• Impaired maternal hemodynamic indices are evident in gestational hypertension, regardless of fetal size, suggesting a significant role for the maternal cardiovascular system.
• Central hemodynamic alterations may contribute to the pathogenesis of hypertensive disorders of pregnancy, warranting consideration alongside placental factors.