The Relationship Between Hemodynamics and Inflammatory Activation in Women at Risk for Preeclampsia

In Brief OBJECTIVE This study evaluated: 1) whether women with risk factors for preeclampsia had a hyperdynamic circulation and increased markers of endothelial and inflammatory activation; and 2) whether hemodynamically directed therapy was associated with a change in markers. METHODS A controlled experimental study was performed for two groups: 1) women at risk for preeclampsia (high risk); and 2) women at low risk (controls). Tumor necrosis factor-α (TNF-α), TNF-α receptors 1 and 2, vascular cell adhesion molecule-1, cellular fibronectin, and cardiac output were measured at or before 24 weeks' gestation and at 6–8 week intervals. High-risk subjects with cardiac output greater than 7.4 L/minute were treated with atenolol. Atenolol therapy was not randomized. Therefore, the longitudinal data were descriptive. Data were analyzed by the t test, Wilcoxon rank sum test, χ2 test, multivariable linear regression, and the standard two-stage test. RESULTS There were 46 high-risk subjects and 25 controls. Maternal age, gestational age, and parity did not differ between the groups. Cardiac output (P < .001) and vascular cell adhesion molecule-1 (P = .02) at baseline were significantly increased in the high-risk group. A total of 42 women in the high-risk group received atenolol for high cardiac output. There was a slower rise in TNF-α receptor 1 in the treated group compared with the controls (P < .001). CONCLUSION Women with risk factors for preeclampsia had a hyperdynamic circulation and endothelial activation. Hemodynamically directed therapy in women at risk was associated with a slower rise in TNF-α receptor 1 compared with low-risk women who were not treated, suggesting a relationship between hemodynamics and inflammatory activation. Hemodynamically directed therapy in women at risk for preeclampsia is associated with a slower rise in tumor necrosis factor-a receptor 1 compared with low-risk women who are not treated.