Maternal hemodynamics at 11-13 weeks' gestation and risk of pre-eclampsia

Objective Women who develop pre-eclampsia are at increased risk of cardiovascular disease and stroke in the subsequent decades. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBPAo) and arterial stiffness, as assessed by pulse wave velocity (PWV) and augmentation index (AIx). The aim of this study was to examine the potential value of assessment of SBPAo, PWV and AIx at 1113 weeks' gestation in identifying women who subsequently develop pre-eclampsia. Methods This was a screening study for pre-eclampsia in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Maternal history and characteristics were recorded and PWV, AIx (adjusted to a heart rate of 75 beats per min (AIx-75)) and SBPAo measured. We compared these parameters in women who developed pre-eclampsia (n = 181) with those in unaffected controls (n = 6766) and examined their performance in screening for pre-eclampsia. Results In the pre-eclampsia group, compared to unaffected controls, there was an increase in AIx-75 (1.13 vs. 1.00 multiples of the median (MoM); P < 0.0001), PWV (1.06 vs. 1.00 MoM; P < 0.0001) and SBPAo (1.09 vs. 1.00 MoM; P < 0.0001). In screening for pre-eclampsia by a combination of maternal variables and log10AIx-75 MoM, log10PWV MoM and log10SBPAo MoM, the estimated detection rate was 56.9% at a false-positive rate of 10%. Conclusion Compared with women who remain normotensive, women who develop pre-eclampsia have higher SBPAo and arterial stiffness, which is apparent from the first trimester of pregnancy. Copyright (C) 2012 ISUOG. Published by John Wiley & Sons, Ltd.