• Echocardiography;
  • maternal cardiac output;
  • pre-eclampsia;
  • pregnancy

Objective  To assess maternal cardiac function in nulliparous women in the first trimester of pregnancy and evaluate its potential role for predicting pre-eclampsia and small for gestational age (SGA).

Design  Prospective, observational, cross-sectional study.

Setting  Maternity unit of a teaching hospital.

Population  Nulliparous women with singleton pregnancies presenting consecutively for routine antenatal care (n= 534).

Methods  Two-dimensional and M-mode echocardiography and uterine artery Dopplers were carried out at 11-14 weeks.

Main outcome measures  Cardiac output (CO), stroke volume (SV), mean arterial pressure (MAP), total vascular resistance and uterine artery pulsatility index (UAPI) were compared in four outcome groups according to the development of pre-eclampsia and/or SGA.

Results  Compared with the normal outcome group (n= 457), in those with pre-eclampsia but not SGA (n = 8), CO and MAP were increased; in the group with pre-eclampsia and SGA (n= 19) MAP, TRP and UAPI were increased and in the group with SGA but no pre-eclampsia (n= 50) total peripheral resistance and UAPI were increased. Independent predictors of pre-eclampsia were MAP, SV and UAPI and of SGA SV and UAPI.

Conclusions  Alterations in maternal cardiac function and UAPI are observed in the first trimester of pregnancy in nulliparous women that subsequently develop pre-eclampsia and/or SGA.