Key result
Assessment of maternal cardiac function at 35-37 weeks' gestation did not improve the performance of screening for pre-eclampsia provided by maternal factors and mean arterial pressure alone.
Why the study?
Does the addition of maternal cardiovascular parameters to maternal factors and MAP improve the prediction of pre-eclampsia and gestational hypertension in singleton pregnancies at 35-37 weeks' gestation?
Observational (n=2,764)
Does the addition of maternal cardiovascular parameters to maternal factors and MAP improve the prediction of pre-eclampsia and gestational hypertension in singleton pregnancies at 35-37 weeks' gestation?
Assessment of maternal cardiac function at 35-37 weeks' gestation does not improve the prediction of pre-eclampsia and gestational hypertension beyond maternal factors and mean arterial pressure alone.
Maternal cardiac assessment at 35-37 weeks should not yet enter PE/GH screening; leaves open value in earlier gestation or refined models.
OBJECTIVE: To investigate the potential value of combining maternal factors with multiples of the normal median values of maternal cardiovascular parameters at 35-37 weeks' gestation in the prediction of pre-eclampsia (PE) and gestational hypertension (GH). METHODS: In 2764 singleton pregnancies maternal characteristics and medical history were recorded; uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP) and maternal cardiovascular parameters were measured. Multivariable logistic regression analysis was then used to determine if the maternal factors and maternal cardiovascular parameters made a significant contribution to predicting PE and GH. The performance of screening was determined by the area under receiver-operating characteristics curves. RESULTS: In pregnancies that subsequently delivered with PE or GH, total peripheral resistance and MAP were higher and maternal cardiac output was lower, mainly owing to a decrease in heart rate in PE and a decrease in stroke volume in GH. The increases in total peripheral resistance and MAP were inversely related to gestational age at delivery. The performance of screening for PE and GH achieved by maternal characteristics and medical history was improved by the inclusion of MAP, but not by UtA-PI or maternal cardiovascular parameters. CONCLUSIONS: In women developing term PE total peripheral resistance and MAP are increased and maternal cardiac output is reduced. However, assessment of maternal cardiac function at 35-37 weeks' gestation is unlikely to improve the performance of screening for PE provided by maternal factors and MAP alone.
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Guy et al. (2016) conducted an observational in Pre-eclampsia and gestational hypertension (n=2,764). Maternal cardiovascular parameters vs. Maternal factors and mean arterial pressure alone was evaluated on Prediction of pre-eclampsia and gestational hypertension. Assessment of maternal cardiac function at 35-37 weeks' gestation did not improve the performance of screening for pre-eclampsia provided by maternal factors and mean arterial pressure alone.
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