Abstract
ObjectivesTo evaluate body water volumes and cardiac output in each trimester of pregnancies complicated with hypertension and/or poor fetal growth, relative to uncomplicated pregnancy.MethodsIn this semi-longitudinal cohort study, a standardised non-invasive maternal hemodynamics assessment in first, second or third trimester was performed in 1068 women with uncomplicated pregnancy (UP), 75 with early onset (EPE) and 117 with late onset preeclampsia (LPE), 139 with gestational hypertension (GH), 129 with small for gestational age (SGA) neonates and 43 with essential hypertension (EH). Women with hypertension or SGA were included prior to onset of symptoms or at diagnosis of disease; 46% of women (758/1631) were assessed in ≥ 2 trimesters. Impedance cardiography and spectrum analysis were used to measure cardiac output, total body water (TBW), extracellular (ECW) and intracellular water (ICW). A linear mixed model was used for inter-trimestrial comparison of parity-, age- and BMI-corrected values within and between groups.ResultsFor all pregnancies, TBW is higher in each consecutive trimester, mainly due to increasing fraction of ECW (ECW%). Compared to first trimester UP, ECW and ECW% are higher in EPE whereas TBW, ECW and ICW are lower in SGA. Compared to inter-trimestrial differences in UP, abnormal changes for body water volumes are observed in GH, EPE and LPE and for CO in EPE and LPE. Changes in EH are not different from UP.ConclusionsThis study is the first to show that concomitant gestational changes of ECW and CO are different from UP already in preclinical stages of pregnancies complicated with hypertension and/or poor fetal growth, except EH. This finding highlights the relevance of early gestational assessment of maternal body fluid status in pregnancies at risk for hypertension or poor fetal growth.
Highlights
A woman’s total body water volume is estimated at around 55% of her body weight
Compared to first trimester uncomplicated pregnancy (UP), extracellular water (ECW) and ECW% are higher in early-onset preeclampsia (EPE) whereas total body water (TBW), ECW and intracellular water (ICW) are lower in small for gestational age (SGA)
Compared to inter-trimestrial differences in UP, abnormal changes for body water volumes are observed in gestational hypertension (GH), EPE and late onset preeclampsia (LPE) and for cardiac output (CO) in EPE and LPE
Summary
A woman’s total body water volume is estimated at around 55% of her body weight. Two third of this volume is intracellular fluid and the remaining third is located extracellularly in the intravascular, interstitial and transcellular compartments [1]. When using bioelectrical impedance technology, it is recommended to consider the measured values not interchangeable with those obtained by other technologies [8], and to use population- and device-specific reference ranges [9] Despite these limitations, several strengths of the BIA technology have been reported, such as (a) its simplicity and low cost, (b) its poor interference by dietary or activity variations [10], (c) its high repeatability and reproducibility when applied under standardised conditions in a variety of selected populations of healthy and chronically ill children/adolescents [11,12,13], healthy adults [14, 15], critically ill [16] and oncologic patients [17], in obese individuals [18] and in pregnant subjects [19, 20]. Maternal measurements are associated with neonatal birth weight [21, 22] and maternal outcome [20, 23,24,25]
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