Maternal cardiac function, uterine artery hemodynamics and natriuretic peptides at 22‐24 weeks of gestation and subsequent development of hypertensive disorders of pregnancy

Abstract

Introduction:Maternal cardiac dysfunction as well as abnormal uterine artery (UtA) Doppler are associated with hypertensive disorders of pregnancy (HDP), but their relation is unclear. We investigated the correlation between maternal cardiac function, UtA hemodynamics and natriuretic peptides, and explored differences between women who subsequently developed HDP and those who did not. Material and methods:This was a prospective cross-sectional cohort study of 347 pregnant women at 22-24 weeks. Maternal cardiac function and systemic hemodynamics were investigated at baseline and after 90 seconds of passive leg raising using impedance cardiography. Preload reserve was defined as percent change (Δ%) in stroke volume and cardiac output from baseline to passive leg raising. UtA hemodynamics was studied using Doppler ultrasonography. UtA blood flow, resistance and pulsatility index were calculated. Fasting venous blood samples were analyzed for natriuretic peptides (pro atrial natriuretic peptide [proANP], N-terminal pro brain natriuretic peptide [Nt-proBNP] and C-type natriuretic peptide [CNP]). The course and outcome of pregnancy were recorded. Results: At baseline, ProANP correlated significantly with cardiac output (r = −0.122; P = .023) and left cardiac work index (r = −0.112; P = .037), whereas Nt-ProBNP correlated significantly with acceleration index (r = .127; P = .018) and velocity index (r = −0.111; P = .039. CNP correlated significantly with UtA blood flow (r = .118; P =.028) and resistance (r = −0.112; P = .037) but not with UtA pulsatility index (r = .034; P = .523). None of the natriuretic peptides correlated with preload reserve. At 22-24 weeks, women who subsequently developed HDP had lower UtA blood flow (552 vs 692 mL/min; P = .028), higher UtA resistance (0.28 vs .17 mmHg/mL/min; P = .004) and higher mean UtA pulsatility index (1.12 vs .84; P < .001) compared with

Genetic Associations of Circulating Cardiovascular Proteins With Gestational Hypertension and Preeclampsia

“…Of those, 3122 individuals (32.0%) experienced an HDP, including 939 (9.6%) with gestational hypertension, 2167 (22.2%) with preeclampsia, and 16 (0.2%) without information on HDP subtype. The most frequently tested biomarker was NT-proBNP (n = 8940; 30 studies), followed by Gal-3 (n = 921; 11 studies), HSP27 (n = 363; 5 studies), and CD40 (n = 81; 2 studies). CSTB and ECP were both evaluated by a single study including 66 participants.…”

Cross‐modality and in‐vivo validation of 4D flow MRI evaluation of uterine artery blood flow in human pregnancy

“…Our findings are consistent with the theory that reduced total UtA flow rate to the placenta is linked with poor pregnancy outcome. While studies of US-based measurements of UtA flow have reported lower flow in cases of PE [23][24][25][26] and SGA 27,28 , technical challenges have precluded the clinical use of US-based UtA flow. US is more operator-dependent than is MRI, and is sensitive to body habitus, angle of insonation and instrument gain artifacts.…”

“…US is more operator-dependent than is MRI, and is sensitive to body habitus, angle of insonation and instrument gain artifacts. As lumen diameter is a significant contributor to accurate measurement of flow, measurements may be difficult to reproduce, since lumen walls may not always be resolved clearly 23 . Furthermore, since the UtAs are often tortuous, absolute measures, such as flow rate, that depend on measurement angle, are challenging to obtain 23 .…”

Lack of an association between first‐trimester concentration of mid‐regional pro‐atrial natriuretic peptide and risk of early‐onset preeclampsia <34 weeks' gestation

“…Also, MRproANP has been found to be inversely associated with incident type 2 diabetes 16 . In uncomplicated pregnancies MRproANP plasma concentrations are similar or slightly higher than in the nonpregnant state, and MRproANP concentrations have been shown to be elevated in the clinical phase of preeclampsia, likely due to the strain on the heart that preeclampsia exerts 9,17–19 …”

“…16 In uncomplicated pregnancies MRproANP plasma concentrations are similar or slightly higher than in the nonpregnant state, and MRproANP concentrations have been shown to be elevated in the clinical phase of preeclampsia, likely due to the strain on the heart that preeclampsia exerts. 9,[17][18][19] MRproANP levels in the first trimester have not been investigated extensively, and most of the published studies focus on the MRproANP in the second and third trimester. Inconsistent results have been found, but some studies have shown elevated concentrations of MRproANP from 22 weeks of gestation in the preclinical phase of preeclampsia.…”