Effect of Parity and Previous Preeclampsia on Maternal Hemodynamics

The effect of parity and previous preeclampsia on the longitudinal maternal hemodynamics during pregnancy has not been studied.

This was a prospective longitudinal study of maternal hemodynamic profile, assessed by transthoracic echocardiography, for women at 12⁺⁰ to 15⁺⁶, 20⁺⁰ to 24⁺⁶, and 30⁺⁰ to 37⁺⁶ weeks of gestation. The study populations were divided into 3 groups: nulliparous women and parous women with and without previous preeclampsia. A linear mixed-effects analysis was performed to compare the longitudinal changes in hemodynamics across gestation among the study groups, controlling for maternal characteristics and medical history in the index pregnancy.

Our study involved 760 nulliparous women, 318 parous women without previous preeclampsia, and 59 parous women with previous preeclampsia. The parous with previous preeclampsia group had the highest median mean arterial pressure and systemic vascular resistance compared with the other 2 groups throughout gestation (all P<0.01). After adjustment for weight, height, chronic hypertension, antihypertensives, aspirin, and development of preeclampsia in the index pregnancy, the estimated marginal mean in mean arterial pressure showed no significant difference among the 3 groups at 20 to 24⁺⁶ and 30⁺⁰ to 37⁺⁶ weeks. Parous women without previous preeclampsia demonstrated a higher estimated marginal mean of cardiac output and a lower estimated marginal mean of systemic vascular resistance compared with nulliparous women throughout gestation (all P<0.05).

The study has revealed that parous women without previous preeclampsia show optimal cardiovascular responses. In contrast, those with a history of preeclampsia exhibit suboptimal cardiovascular adaptation, and the cardiovascular changes observed from the second trimester in the index pregnancy are attributed to maternal characteristics and the development of preeclampsia.