35 Body composition and volume distribution in normal and ypertensive pregnancies

Abstract

Background Volume assessment in the pre-eclampsia is difficult. Intravascular volume contraction and oliguria in the face of extracellular volume overload and oedema appears to be accepted yet often difficult to manage. The relationship between clinically evident oedema and volume status is not clear. Aim To examine the distribution of fluid in normal and hypertensive pregnancies using a non-invasive technique. Methods Women in their 3rd trimester in a cross sectional study. There were five groups: normotensive pregnancy (NP); gestational hypertension (GH); essential hypertension (EH), pre-eclampsia (PE) and non-pregnant controls (C). Each study participant had their body composition, including total body water (TBW), intracellular volume (ICW) & extracellular volume (ECW) as well as over hydration (OH) measured using the Fresenius BCM®. Body Mass Index (BMI) was calculated and % fat mass measured using BCM. Results A total of 128 women have been recruited to date as follows; NP = 20 GH = 51, EH = 16, PE = 14 and C = 27. Download : Download high-res image (214KB) Download : Download full-size image Pregnant women had higher TBW and ECW than the control group (p 0.05). However amongst the pregnant women there was no difference in measured fluid in any of the compartments despite a trend in those with PE toward fluid overload. Hypertensive pregnant women were also bigger than their normotensive pregnant counterparts. Conclusion In this small cohort we were unable to find a clear difference in volume status among women with normotensive pregnancies, those with uncomplicated hypertensive disorders of pregnancy EH & GH or clinically evident PE. We were however able to determine that women with PE tended to be more over hydrated than women with other hypertensive disorders of pregnancy. Small numbers in this group may have impacted the power of this result however. Future studies combining this technique with non-invasive cardiac output monitoring could perhaps yield a more comprehensive fluid assessment in this challenging group of patients.