Early-pregnancy changes in cardiac diastolic function in women with recurrent pre-eclampsia and in previously pre-eclamptic women without recurrent disease

Authors


Dr SJS Sep, Department of Internal Medicine, The Maastricht Study, PO Box 616, 6200 MD Maastricht, the Netherlands. Email s.sep@mumc.nl

Abstract

Please cite this paper as: Sep S, Schreurs M, Bekkers S, Kruse A, Smits L, Peeters L. Early-pregnancy changes in cardiac diastolic function in women with recurrent pre-eclampsia and in previously pre-eclamptic women without recurrent disease. BJOG 2011;118:1112–1119.

Objective  To compare early-pregnancy changes in cardiac diastolic function between formerly pre-eclamptic women with (RECUR) and without (NORECUR) recurrent pre-eclampsia.

Design  Retrospective observational cohort study.

Setting  Tertiary referral centre.

Population  Pregnant women with a history of early-onset pre-eclampsia (= 34).

Methods  The peak mitral filling velocity in early diastole (E) and at atrial contraction (A), and the E/A ratio were assessed before and at 12, 16 and 20 weeks of gestation in the next pregnancy. Differences in early-pregnancy alterations between women with (RECUR) and without (NORECUR) recurrent pre-eclampsia were evaluated by use of mixed design analysis of covariance.

Main outcome measures  Cardiac function and recurrent pre-eclampsia.

Results  In ten women (29%) pre-eclampsia recurred. By 12 weeks of gestation the E/A ratio had increased in the RECUR group, but not in the NORECUR group (P < 0.01). Moreover, from 16 weeks of gestation onwards, the RECUR group had a lower cardiac output and higher systemic vascular resistance as compared with the NORECUR group (P < 0.05).

Conclusion  Our results suggest that formerly pre-eclamptic women destined to develop recurrent pre-eclampsia differ from their counterparts who do not develop recurrent pre-eclampsia by impaired first-trimester adaptation of cardiac diastolic function.

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