Mid-gestational maternal cardiovascular profile in preterm and term pre-eclampsia: a prospective study

Objective: Pre-eclampsia (PE) is associated with maternal cardiac remodelling and biventricular diastolic dysfunction. Preterm PE alone can also be associated with severe left ventricular hypertrophy and biventricular systolic dysfunction. The aim of this study was to assess whether the maternal cardiovascular profile at mid-gestation in nulliparous normotensive women differs in women destined to develop preterm PE versus those who will develop PE at term.

Design: Prospective study.

Setting: Tertiary referral university centre.

Population: A total of 269 women, including 152 at increased risk of developing PE as determined by mid-gestational uterine artery Doppler assessment.

Methods: Women underwent blood pressure profiling, echocardiography, cardiac tissue Doppler and strain rate analysis at 20-23 weeks of gestation.

Main outcome measures: Mid-gestational cardiovascular profile in women with normal pregnancy and those that subsequently developed preterm or term PE.

Results: Pre-eclampsia subsequently developed in 46 women, including 18 with preterm PE. Women who subsequently developed PE, irrespective of gestation, had evidence of left ventricular concentric remodelling (33%) which was not found in the control women (P < 0.0001). Only women who developed preterm PE exhibited a high resistance-low volume haemodynamic state at mid-gestation. The latter group also had evidence of left ventricular diastolic or systolic dysfunction (33%) and segmental impaired myocardial relaxation (72%).

Conclusions: Asymptomatic cardiac diastolic dysfunction is evident at mid-gestation in women who subsequently develop preterm PE but not in those who develop term PE. These cardiac findings are useful in understanding the pathophysiology of PE and corroborate the concept that PE is not a single disorder, but a cluster of symptoms that have several different aetiologies.