Preeclampsia is Preceded by Cardiovascular Function Abnormalities

Olga Paez, Pablo Puleio, Miguel Visser, Silvina Mazzeo, Leandro Antelo, Juan Alderete, Rubén Kevorkian, Claudio Majul


Background: Preeclampsia (PE) is associated with changes in cardiovascular function (CVF), but whether these changes precedeand persist in the clinical phase of the disease is still unknown.Objectives: The aim of this study was to evaluate the differences in CVF at 22 weeks of pregnancy and one year after delivery inpatients who developed PE vs. those with normotension (N). The association between CVF at 22 weeks of pregnancy and the developmentof PE was also analyzed.Methods: A prospective study was conducted including 260 normotensive primiparous women. Routine laboratory tests, 24-hoururine protein and blood pressure (BP) were measured at 22 weeks and one year after delivery. Cardiac index (CI), systemic vascularresistance index (SVRI), and pulse wave velocity (PWV) were measured by impedance cardiography. The population was divided intothree groups according to the outcome during pregnancy: G1: PE, G2: gestational hypertension (GH) and G3: N. The results arepresented as mean ± SD, ANOVA and post hoc test, p <0.05.Results: Twelve patients evolved to PE, 18 to GH and 220 remained with N. In G1, CI was lower and BP, SVRI and PWV were higherthan in G3 at 22 weeks of pregnancy and one year after delivery. In G2, values were always intermediate between G1 and G3. PWVand SVRI measured at 22 weeks of pregnancy resulted predictors of PE.Conclusions: Patients who developed PE had different CVF in the early stage of pregnancy than those with normotension. The earlydiagnosis of those changes could predict PE and thus contribute to prevent its complications.


Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, Vogel JP, et al. On behalf of the WHO Multicountry Survey on Maternal and Newborn Health Research Network. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014;121(suppl 1):14-24. hHttps://

Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ 2013;347:f 6564

Fox A, McHugh S, Browne J, Kenny LC, Fitzgerald A, Khashan AS, et al. Estimating the cost of preeclampsia in the healthcare system: cross-sectional study using data from SCOPE study (Screening for Pregnancy End Points). Hypertension 2017;70:1243-9.

Thilaganathan B, Kalafat E. Cardiovascular System in Preeclampsia and Beyond. Hypertension 2019;73:522-31.

Vasapollo B, Novelli GP, Valensise H. Total vascular resistance and left ventricular morphology as screening tools for complications inpregnancy. Hypertension 2008;51:1020-6.

Scardo JA, Ellings J, Vermillion ST, Chauhan SP. Validation of bioimpedance estimates of cardiac output in preeclampsia. Am J Obstet Gynecol 2000;183:911-3.

Hausvatera A, Giannonea T, Sandoval YH, Doonana RJ, Antonopoulos CN, Matsoukis IL, et al. The association between preeclampsia and arterial stiffness. J Hypertens 2012;30:17-33.

Osman MW, Nath M, Khalild A, Webb DR. Robinson TG, Mousa HA. Longitudinal study to assess changes in arterial stiffness and cardiac output parameters among low-risk pregnant women. Pregnancy Hypertens 2017;10:256-61.

Bosio PM, McKenna PJ, Conroy R, O'Herlihy C. Maternal central hemodynamics in hypertensive disorders of pregnancy. Obstet Gynecol 1999;94:978-84.

Valensise H, Vasapollo B, Gagliardi G and Novelli GP. Early and Late Preeclampsia Two Different Maternal Hemodynamic States in the Latent Phase of the Disease. Hypertension 2008;52:873-80.

Ahmed R, Dunford J, Mehran R, Robson S, Kunadian V. Pre-Eclampsia and Future Cardiovascular Risk Among Women. J Am Coll Cardiol 2014;63:1815-22.

Weissgerber TL, Milic NM, Milin-Lazovic JS and Garovic VD. Impaired Flow-Mediated Dilation Before, During and After Preeclampsia: A Systematic Review and Meta-analysis. Hypertension 2016;67:415-23.

Goulopoulou S. Maternal Vascular Physiology in Preeclampsia. Hypertension 2017;70:1066-73.

Sociedad Argentina de Cardiología, Federación Argentina de Cardiología y de la Sociedad Argentina de Hipertensión Arterial. Consenso Argentino (Supl. 2): 1-49.

Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017

ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71:1269-324.

Kubicek WG, Kottke J, Ramos MU, Patterson RP, Witsoe DA, Labree JW, et al. The Minnesota impedance cardiograph- theory and applications. Biomed Eng (NY) 1974; 9:410-6.

Morales MS, Cuffaro P, Barochiner J, Rada MA, Alfie J, Aparicio L, et al. Validation of a new piezo-electronic device for non-invasive. measurement of arterial pulse wave velocity according to the artery society guidelines. Artery Res 2015;10:32-7·

Rasmussen S and Irgens LM. History of Fetal Growth Restriction Is More Strongly Associated with Severe Rather Than Milder Pregnancy-Induced Hypertension. Hypertension 2008;51:1231-8.

Ngene NC, Moodley J. Physiology of blood pressure relevant to managing hypertension in pregnancy. J Matern Fetal Neonatal Med. 2017; 27:1-10.

Granger JP, Alexander BT, Llinas MT, Bennett WA, and Khalil R. Pathophysiology of Hypertension During Preeclampsia Linking Placental Ischemia With Endothelial Dysfunction. Hypertension 2001;38:718-22.

Foo FL, Mahendru AA, Masini G, Fraser A, Cacciatore S, MacIntyre D, McEniery CM et al. Association Between Prepregnancy Cardiovascular Function and Subsequent Preeclampsia or Fetal Growth Restriction. Hypertension 2018;72:442-50.

San-Frutos LM, Fernández R, Almagro J, Barbancho C, Salazar F, Pérez-Medina T, et al. Measure of hemodynamic patterns by thoracic electrical bioimpedance in normal pregnancy and in preeclampsia. Eur J Obstet Gynecol Reprod Biol 2005;121:149-53.

Brown MA, MageeLA, Kenny LC, Karumanchi A, McCarthy FP, Saito S, et al. On behalf of the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive Disorders of Pregnancy ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension 2018; 72:24-43.

McLaughin K, Scholten RR, Kingdom JC, Floras JS and Parker JD. Should Maternal Hemodynamics Guide Antihypertensive Therapy in Preeclampsia? Hypertension 2018;71:550-6.

McLaughlin K, Zhang J, Lye SJ, Parker JD and Kingdom JC. Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy. J Am Heart Assoc 2018;7:e009595.

Reyes LM, Usselman CW, Davenport MH and Steinback CD. Sympathetic Nervous System Regulation in Human Normotensive and Hypertensive Pregnancies. Hypertension 2018;71:793-803.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020