103: Pregnancies complicated by hypertensive disease demonstrate a high resistance vasculature in the postpartum period- results of the prospective HANDLE study

Abstract

Our aim was to assess if the aberrant changes measured by non-invasive cardiac output monitoring (NICOM) in women with pregnancies complicated by Gestational Hypertension (GH), Preeclampsia (PE), or Fetal growth restriction (FGR) persist postpartum. Low risk nulliparous women were enrolled in a single center prospective study assessing the ability of NICOM to predict the evolution of GH, PE and FGR, as part of the HANDLE study. NICOM was performed at >6 weeks postpartum. Hemodynamic variables assessed included cardiac output (CO), indexed cardiac output (CO), total peripheral resistance (TPR), indexed total peripheral resistance (TPRI), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), stroke volume (SV) and indexed stroke volume (SVI). Comparison was made to 30 matched non-pregnant controls. Statistical analysis was performed by independent t-test using SPSS Version 23. Of 318 recruits, 291 (79.5%) of women attended the postpartum review. Four pregnancies were affected by PE, 17 by GH, 18 by FGR and 252 uncomplicated pregnancies. In comparison to non-pregnant values, uncomplicated pregnancies postnatally exhibited an increase in TPRI (p=0.04) and a decrease in COI (p<0.001), SV (p=0.003) and SVI (p<0.001) while HR, CO, TPR and BP were unchanged. FGR pregnancies exhibited a similar trend but did not achieve significance. Pregnancies complicated by hypertensive disease in the postpartum period maintained a lower SVI (p=0.04) but higher SBP (p=0.03), DBP (p=0.01), HR (p<0.05) and TPRI (p=0.009) when compared to non-pregnant values (Table 1). Pregnancy is associated with hemodynamic changes, which persist in the postpartum period. Women with pregnancies complicated by GH/PE were characterised by persistently higher intravascular resistance, coupled with persistently elevated blood pressures. This altered postnatal adaption may explain why women with a pregnancy complicated by PE have a life-long increased risk of cardiovascular disease.