Impaired maternal hemodynamics in morbidly obese women: a case–control study

Vinayagam, Dimuthu; Gutiérrez, J.; Binder, Julia; Mantovani, E.; Thilaganathan, B.; Khalil, Asma

doi:10.1002/uog.17428

Cited by 34 publications

(25 citation statements)

References 16 publications

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“…Furthermore, the increase in blood pressure seen with increasing maternal weight is due to an increase in CO, which is independent of SVR. Previous work by our group has shown no difference in SVR between morbidly obese pregnant women and controls with normal BMI. Future studies to assess the structural and functional myocardial changes (using echocardiography) associated with increased maternal weight and, more specifically, weight gain in pregnancy, are required to explore this.…”

Section: Discussionmentioning

confidence: 81%

Maternal hemodynamics in normal pregnancy: reference ranges and role of maternal characteristics

Vinayagam

Thilaganathan

Stirrup

et al. 2018

Ultrasound in Obstet & Gyne

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Maternal hemodynamics are influenced significantly by maternal age, height and weight. We provide USCOM-1A-specific reference ranges and a calculator for SV, CO and SVR in uncomplicated pregnancies that correct for maternal age, height and weight. This should enable clinical application and comparison in both uncomplicated and pathological pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 81%

Maternal hemodynamics in normal pregnancy: reference ranges and role of maternal characteristics

Vinayagam

Thilaganathan

Stirrup

et al. 2018

Ultrasound in Obstet & Gyne

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“…Thoracic fluid content (1/kΩ) 25 (24)(25)(26)(27) 23 (21)(22)(23)(24)(25)(26) .0001 26 (24-28) 24 (22)(23)(24)(25)(26)(27) .0001 26 (24-30) 24 (22)(23)(24)(25)(26)(27) .0001…”

Section: Intracellular Water (L)mentioning

confidence: 99%

“…Higher heart rates and blood pressures, but no differences in stroke volume, cardiac output or total peripheral resistance, were found in reported obesity studies with pregnant women. However, those studies do not provide full information of all trimesters or consider the maternal circulation only partially . We aim to investigate the maternal circulatory differences between uncomplicated obese and normal weight pregnancies by applying a combined assessment of the important parts of the circulation (heart, central and peripheral arteries, central veins and body fluid) during first, second and third trimester, and hypothesize that the haemodynamic function is different in these two groups, both at start and during course of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21] An obese woman starts pregnancy with a pre-existing chronical endothelial dysfunction and diverse haemodynamically aberrations which might influence the normal physiological changes occurring during pregnancy. 22 Higher heart rates 23,24 and blood pressures, 24 but no differences in stroke volume, cardiac output or total peripheral resistance, 24 were found in reported obesity studies with pregnant women. However, those studies do not provide full information of all trimesters or consider the maternal circulation only partially.…”

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confidence: 99%

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Obesity in pregnancy causes a volume overload in third trimester

Vonck

Lanssens

Staelens

et al. 2019

Eur J Clin Investigation

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Background Obesity is a major risk factor for cardiovascular diseases. In this study, we aimed to investigate the maternal circulatory differences during pregnancy between obese and normal weight women. Materials and methods The functioning of the maternal circulation (arteries, veins, heart and body fluid) was assessed by ECG‐Doppler ultrasound, impedance cardiography (ICG) and bio‐impedance during pregnancy in obese women (BMI ≥30 kg/m2) and normal weight, nonobese women (BMI 20‐25 kg/m2). In this observational study, 232 assessments were performed in the obese group, whereas 919 assessments were performed in the nonobese group. Results Relative to nonobese women, the overall cardiovascular function in obese women during first and second trimester is consistent with a high volume/low‐resistance circulation. In third trimester, cardiac output of obese women decreases from 9.2 (8.2‐10.7) L/min to 8.5 (7.6‐9.6) L/min (P = .037) whereas this is not true in the nonobese women (from 7.8 (7‐8.5) L/min to 7.8 (6.8‐8.9) L/min, P = .536). Simultaneously, the persistently lower peripheral vascular resistance in obese vs nonobese women disappears (880 (761‐1060) dyn.sec/cm5 vs 928 (780‐1067). Conclusions The circulatory gestational adaptations between nonobese and obese women were generally similar. The findings in the third trimester suggest that a pregnancy in obese women start as a state of high volume/low resistance, gradually shifting to a volume overload with decrease of cardiac output and disappearance of low vascular resistance. This evolution makes obese women vulnerable for gestational hypertensive diseases.

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“…Recently a new device has been introduced for the measurement of SV and CO in pregnancy, the UltraSonic Cardiac Output Monitor (USCOM 1A®). This is a non‐invasive hemodynamic monitor that measures cardiovascular values by using a non‐imaging continuous‐wave Doppler transducer placed on the suprasternal notch to determine ascending transaortic blood flow (Figure ).…”

Section: Methods Of Co Measurementmentioning

confidence: 99%

Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics

Bijl

Valensise

Novelli³

et al. 2019

Ultrasound in Obstet & Gyne

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Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non‐invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical‐care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Impaired maternal hemodynamics in morbidly obese women: a case–control study

Cited by 34 publications

References 16 publications

Maternal hemodynamics in normal pregnancy: reference ranges and role of maternal characteristics

Maternal hemodynamics in normal pregnancy: reference ranges and role of maternal characteristics

Obesity in pregnancy causes a volume overload in third trimester

Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics

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