Early pregnancy maternal cardiovascular profiling in the prediction of hypertensive disease in pregnancy

Prediction of hypertensive disease in pregnancy remains challenging. Risk factor based screening utilizing history, physical characteristics, uterine artery Doppler and serum markers have been used with varying success. As hypertension in pregnancy appears to be associated with changes in the maternal vasculature, we have investigated the utility of maternal arterial elasticity measurement, prior to 20 weeks gestation, in the prediction of hypertensive disease in pregnancy. A HDI/Pulsewave CR2000 Research Cardiovascular Profiling System was used to obtain radial artery pulse pressure waveforms from 623 Caucasian women at the time of their first antenatal visit. Outcome data were available in 610 cases and these comprised the study group. The results showed that women who subsequently developed gestational hypertension (n = 20) had higher baseline systolic, diastolic and pulse pressure values (though within the normal range) but similar arterial elasticity to those patients who did not develop hypertension. Women who later developed pre-eclampsia (n = 23) had, in addition, reduced large artery elasticity and increased systemic vascular resistance compared with women who did not develop hypertension. The measurement of maternal radial artery elasticity in early pregnancy may provide an additional refinement in screening for hypertensive disease, particularly pre-eclampsia, in pregnancy.