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Early Pregnancy Circulatory Adaptation and Recurrent Hypertensive Disease: An Explorative Study

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Abstract

Introduction

Hypertensive pregnancy disorders are assumed to be preceded by defective spiral artery remodeling. Whether this localized aberration at the implantation site affects the initial maternal systemic cardiovascular and renal adaptation to pregnancy is unclear. We explored in a high-risk population, whether the initial systemic maternal adaptation to pregnancy differs between women who do and do not develop a recurrent hypertensive disorder later on in pregnancy.

Methods

We enrolled 61 normotensive women with a previous hypertensive disorder of pregnancy and subdivided them into 2 subgroups, based on whether or not their next pregnancy remained uneventful (n = 33) or became complicated by a recurrent hypertensive disorder (n = 28). We measured before pregnancy and again at 18 ± 2 weeks of gestation cardiac output, blood pressure, plasma volume, creatinine clearance, and calculated total peripheral vascular resistance from cardiac output and blood pressure.

Result

Both subgroups responded to pregnancy with an increase in cardiac output, plasma volume, heart rate, and creatinine clearance, and a decrease in blood pressure and total peripheral vascular resistance. Women who developed a recurrent hypertensive disorder differed from their counterparts with an uneventful next pregnancy by smaller pregnancy-induced increases in creatinine clearance (19% vs 31%, P = .035) and cardiac output (10% vs 20%, P = .035), respectively.

Conclusion

The initial systemic cardiovascular and renal adaptations to pregnancy in women who develop a recurrent gestational hypertensive disorder differ from those in their counterparts with an uneventful next pregnancy by smaller rises in creatinine clearance and cardiac output.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Maastricht University Medical Center, Universiteitssingel 50, PO Box 5800, 6202 AZ, Maastricht, the Netherlands

    V. A. Lopes van Balen MD, J. J. Spaan MD, PhD, C. Ghossein MD, S. M. J. van Kuijk MSc, M. E. A. Spaanderman MD, PhD & L. L. H. Peeters MD, PhD

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  1. V. A. Lopes van Balen MD
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  2. J. J. Spaan MD, PhD
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  3. C. Ghossein MD
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  4. S. M. J. van Kuijk MSc
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  5. M. E. A. Spaanderman MD, PhD
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  6. L. L. H. Peeters MD, PhD
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Correspondence to V. A. Lopes van Balen MD.

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Lopes van Balen, V.A., Spaan, J.J., Ghossein, C. et al. Early Pregnancy Circulatory Adaptation and Recurrent Hypertensive Disease: An Explorative Study. Reprod. Sci. 20, 1069–1074 (2013). https://doi.org/10.1177/1933719112473658

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