OJOG  Vol.4 No.2 , February 2014
Early pregnancy maternal cardiovascular profiling in the prediction of hypertensive disease in pregnancy

Prediction of hypertensive disease in pregnancy remains challenging. Risk factor based screening utilizing history, physical characteristics, uterine artery Doppler and serum markers have been used with varying success. As hypertension in pregnancy appears to be associated with changes in the maternal vasculature, we have investigated the utility of maternal arterial elasticity measurement, prior to 20 weeks gestation, in the prediction of hypertensive disease in pregnancy. A HDI/Pulsewave CR2000 Research Cardiovascular Profiling System was used to obtain radial artery pulse pressure waveforms from 623 Caucasian women at the time of their first antenatal visit. Outcome data were available in 610 cases and these comprised the study group. The results showed that women who subsequently developed gestational hypertension (n = 20) had higher baseline systolic, diastolic and pulse pressure values (though within the normal range) but similar arterial elasticity to those patients who did not develop hypertension. Women who later developed pre-eclampsia (n = 23) had, in addition, reduced large artery elasticity and increased systemic vascular resistance compared with women who did not develop hypertension. The measurement of maternal radial artery elasticity in early pregnancy may provide an additional refinement in screening for hypertensive disease, particularly pre-eclampsia, in pregnancy.

Cite this paper
Hogan, J. , O’Dwyer, V. , Farah, N. , Kennelly, M. , Turner, M. and Stuart, B. (2014) Early pregnancy maternal cardiovascular profiling in the prediction of hypertensive disease in pregnancy. Open Journal of Obstetrics and Gynecology, 4, 61-65. doi: 10.4236/ojog.2014.42011.
[1]   Poon, L.C., Kametas, N.A., Maiz, N., Akolekar, R. and Nicolaides, K.H. (2009) First-trimester prediction of hypertensive disorders in pregnancy. Hypertension, 53, 812-818. http://dx.doi.org/10.1161/HYPER TENSIONAHA.108.127977

[2]   (2012) Coombe Women and Infant’s University Hospital Annual Clinical Report, 43.

[3]   Conde-Agudelo, A. and Belizan, J.M. (2000) Risk factors for pre-eclampsia in a large cohort of Latin American and Caribbean women. BJOG, 107, 75-83. http://dx.doi.org/10.1111/j.1471-0528.2000. tb11582.x

[4]   Cudihy, D. and Lee, R.V. (2009) The pathophysiology of pre-eclampsia: Current clinical concepts. Journal of Obstetrics & Gynaecology, 29, 576-582. http://dx.doi.org/10.1080/01443610903061751

[5]   Redman, C.W. and Sargent, I.L. (2003) Pre-eclampsia, the placenta and the maternal systemic inflammatory response—A review. Placenta, 24, S21-S27.

[6]   Redman, C.W. and Sargent, I.L. (2005) Latest advances in understanding preeclampsia. Science, 308, 1592-1594. http://dx.doi.org/10.1126/science.1111726

[7]   Cohn, J.N., Hoke, L., Whitwam, W., Sommers, P.A., Taylor, A.L., Duprez, D., Roessler, R. and Florean, N. (2003) Screening for early detection of cardiovascular disease in asymptomatic individuals. American Heart Journal, 146, 679-685. http://dx.doi.org/10.1016/S0002-8703(03)00499-X

[8]   Centre for Maternal and Child Enquiries (CMACE) (2011) Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer: 2006-08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG, 118, 1-203.

[9]   Rooney, C. (1992) Antenatal care and maternal health: How effective is it—A review of the evidence. World Health Organization.

[10]   Conde-Agudelo, A., Villar, J. and Lindheimer, M. (2004) World Health Organization systematic review of screening tests for preeclampsia. Obstetrics & Gynecology, 104, 1367-1391.

[11]   Roberts, J.M., Taylor, R.N., Musci, T.J., Rodgers, G.M., Hubel, C.A. and Mclaughlin, M.K. (1989) Preeclampsia: An endothelial cell disorder. American Journal of Obstetrics & Gynecology, 161, 1200-1204. http://dx.doi.org/10.1016/0002-9378(89)90665-0

[12]   Briceno-Perez, C., Briceno-Sanabria, L. and Vigil-De Gracia, P. (2009) Prediction and prevention of preeclampsia. Hypertens Pregnancy, 28, 138-155. http://dx.doi.org/10.1080/10641950802022384

[13]   Khalil, A.A., Cooper, D.J. and Harrington, K.F. (2009) Pulse wave analysis: A preliminary study of a novel technique for the prediction of pre-eclampsia. BJOG, 116, 268-276.