Maternal hemodynamics in screen‐positive and screen‐negative women of the ASPRE trial. (24th May 2019) - Ling, H. Z.
ABSTRACT: Objective: To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre‐eclampsia (PE) or deliver a small‐for‐gestational‐age (SGA) neonate, between those identified at 11–13 weeks' gestation as being screen positive or negative for preterm PE, by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and pregnancy associated plasma protein‐A. Methods: This was a prospective longitudinal cohort study of maternal cardiovascular function, assessed using a bioreactance method, in women undergoing first‐trimester screening for PE. Maternal hemodynamics and perinatal outcome were compared between screen‐positive and screen‐negative women who did not have a medical comorbidity, did not develop PE or pregnancy‐induced hypertension and delivered at term a live neonate with birth weight between the 5 th and 95 th percentiles. A multilevel linear mixed‐effects model was used to compare the repeated measures of cardiac variables, controlling for maternal characteristics. Results: The screen‐negative group ( n = 926) had normal cardiac function changes across gestation, whereas the screen‐positive group ( n = 170) demonstrated static or reduced cardiac output and stroke volume and higher mean arterial pressure and peripheral vascular resistance with advancing gestation. In the screen‐positive group, compared with screen‐negative women, birth‐weight Z ‐score was shifted toward lower values, with prevalence of delivery of a neonate below the 35 th, 30 th or 25 th percentile being about 70% higher, and the rate of operative delivery for fetal distress in labor also being higher. Conclusion: Women who were screen positive for impaired placentation, even though they did not develop PE or deliver a SGA neonate, had pathological cardiac adaptation in pregnancy and increased risk of adverse perinatal outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.