125. Peripheral maternal haemodynamic adaptation across gestation in hypertensive disorders of pregnancy

Abstract

Introduction Preeclampsia is characterized by haemodynamic maladaptation but the timing of its onset is controversial. Objective To evaluate maternal haemodynamics across pregnancy in hypertensive disorders of pregnancy (HDP) compared to uncomplicated pregnancies. Study design Prospective cohort study from 2015–2018 of healthy, nulliparous, singleton-bearing women. Maternal haemodynamic adaptation between 11 and 32 weeks’ gestation in pregnancies complicated by HDP: preeclampsia with severe (sPE) and without severe features (nsPE), gestational hypertension (GH) and occasionally hypertensive (OH) were compared uncomplicated pregnancies using mixed-effects linear modelling. Main outcome measures Maternal haemodynamics assessed by Uscom BP+ [peripheral and central blood pressure (BP), augmentation index (AIx)] in uncomplicated pregnancies and those complicated by HDP. Results Maternal haemodynamics at 11 weeks’ were different in all hypertensive groups compared to uncomplicated pregnancies (n = 286). When corrected for initial measurement, women who developed sPE (n = 12) and nsPE (n = 49) had a relative haemodynamic maladaptation by 34 weeks’. Compared to those with uncomplicated pregnancies, preeclamptics showed an additional increase in peripheral systolic BP [SBP; 14.33 mmHg, 8.61–20.05 (sPE)], peripheral diastolic BP [DBP; 7.70 mmHg, 3.31–12.09 (sPE); 2.58 mmHg, 3.31–12.09 (nsPE)], peripheral mean arterial pressure [MAP; 10.60 mmHg, 5.75–15.45 (sPE); 3.39 mmHg, 0.83–5.96 (nsPE)], peripheral pulse pressure [PP; 6.63 mmHg, 2.13–11.13 (sPE)], central SBP [15.83 mmHg, 10.43–21.22 (sPE); 2.94 mmHg, 0.08–5.80 (nsPE)], central DBP [8.26 mmHg, 3.89–12.64 (sPE); 2.46 mmHg, 0.15–4.78 (nsPE), central MAP [10.79 mmHg, 6.39–15.19 (sPE); 2.62 mmHg, 0.29–4.95 (nsPE)], central PP [7.57 mmHg, 3.85–11.28 (sPE)] and AIx decreased less (15.48% 6.32–24.65 (sPE); 9.00% (4.15–13.56 (nsPE)]. Haemodynamic adaptation in women who developed GH (n = 25) and OH (n = 33) was similar to those with uncomplicated pregnancies. Conclusion Haemodynamic adaptation in women who develop preeclampsia was altered, while those who develop GH or OH had comparable haemodynamic changes, to those with uncomplicated pregnancies. These data indicate that women with preeclampsia fail to undergo proper cardiovascular adaptation to pregnancy. This occurs as early as the first trimester.