Ferrazzi E, et al. - Analysts analyze cardiovascular parameters in a cohort of patients influenced by hypertensive disorders of pregnancy (HDP) as indicated by the clinical phenotypes that prioritize fetoplacental attributes and not the time at the onset of HDP. Significantly low cardiac output and high total vascular resistance portrayed the women with HDP related to SGA because of placental insufficiency, independent of the gestational age at the onset of hypertension. The cardiovascular parameters were not significantly different in the women with AGA or SGA fetuses who were affected by preeclampsia or gestational hypertension. These outcomes support the view that maternal hemodynamics may be a candidate diagnostic tool to identify hypertensive disorders in pregnancies associated with SGA fetuses. This additional tool matches other reported evidence provided by uterine Doppler velocimetry, low vascular growth factors in the first trimester, and placental pathology. Obesity is related to a significantly higher cardiac output and outweighs other determinants of hemodynamics in pregnancy; therefore, in future studies on hypertensive disorders, obesity ought to be studied as an additional disease and not simply as a demographic characteristic.

Methods

• At the Fetal Maternal Medicine Unit of Ziekenhuis Oost-Limburg (Genk, Belgium), maternal cardiovascular parameters were obtained through impedance cardiography utilizing a non-invasive continuous cardiac output monitor (NICCOMO©,) with the patients placed in a standing position.
• The patients were classified as follows: pregnant women with HDP who delivered appropriate for gestational age (AGA) fetuses and pregnant women with HDP who delivered small for gestational age (SGA) fetuses.
• Normotensive pregnant women with an AGA fetus at delivery were enlisted as the control group.
• The possible effect of obesity (Body Mass Index ≥30 kg/m²) on maternal hemodynamics was reassessed in the same groups.

Results

• In this study, maternal age, parity, BMI, and blood pressure were not significantly different between the HDP-AGA and HDP-SGA groups.
• They also noticed that the mean uterine artery PI was highly significantly higher in the HDP-SGA group.
• The cardiac output (CO) and cardiac index (CI) were significantly lower in the HDP-SGA group (CO=6.5 L/min, CI=3.6) than in the HDP-AGA group (CO=7.6 L/min, CI 3.9) but not between the HDP-AGA and control group (7.6 L/min, CI=4.0).
• Total vascular resistance (TVR) was significantly higher in the HDP-SGA group than in the HDP-AGA group and the control group.
• All HDP women showed signs of central arterial dysfunction.
• The cardiovascular parameters were not influenced by gestational age at the onset of HDP, and no difference was seen between the women with AGA fetuses influenced by preeclampsia or by gestational hypertension with AGA fetuses.
• The obese-HDP-AGA and obese-HDP-SGA women demonstrated a significant increase in cardiac output, as well as significant changes in other parameters, compared with the non-obese HDP-AGA and non-obese HDP-SGA women.