Preeclampsia: Maternal cardiovascular function and optimising outcomes

Area of Science:

• Cardiovascular Physiology
• Obstetrics
• Perinatology

Background:

• Preeclampsia is linked to cardiac dysfunction extending beyond the clinical phase, affecting long-term maternal and neonatal cardiovascular health.
• Abnormal cardiovascular function predates conception, suggesting pre-existing conditions contribute to preeclampsia development.

Approach:

• This review synthesizes current evidence on cardiovascular function changes in preeclampsia.
• It examines the timeline of cardiovascular dysfunction onset and identifies two distinct preeclampsia phenotypes.
• Phenotype 1: Associated with fetal growth restriction, low cardiac output, and high peripheral resistance.
• Phenotype 2: Associated with normal fetal growth, high cardiac output, and low peripheral resistance.

Key Points:

• A pre-conception cardiovascular phenotype indicates potential for preeclampsia prevention through early cardiovascular optimization.
• Understanding the two distinct phenotypes allows for targeted therapeutic strategies.
• Addressing preeclampsia is crucial for improving long-term maternal and neonatal cardiovascular well-being.

Conclusions:

• Cardiovascular dysfunction is integral to preeclampsia, manifesting before, during, and after pregnancy.
• Early identification of cardiovascular phenotypes offers a window for preventative interventions.
• Targeted therapies based on specific phenotypes can optimize cardiovascular function and improve outcomes.