Prognostic Value of Maternal Cardiovascular Hemodynamics in Women With Gestational Hypertension and Chronic Hypertension in Pregnancy

Date

2020-08-01

Author

Kalafat, Erkan
Perry, Helen
Bowe, Sophie
Thilaganathan, Basky
Khalil, Asma

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This study aimed to assess the prognostic value of cardiovascular assessment in women with gestational hypertension or chronic hypertension for the risk of preeclampsia and need for closer antenatal surveillance. This was a prospective study of pregnancies complicated by gestational hypertension or chronic hypertension presenting to St George's Hospital, between January 2015 and May 2018. A noninvasive ultrasonic cardiac output monitor was used to obtain cardiovascular variables of cardiac output (CO) and systemic vascular resistance (SVR) and weight-adjusted indices. The primary outcome was the time to development of preeclampsia in women with gestational hypertension or chronic hypertension. In women with gestational hypertension or chronic hypertension (n=149), cox-proportional hazards analysis showed that mean arterial pressure (P=0.006), Afro-Caribbean ethnicity (P=0.045), and gestational age at the time of diagnosis above 34 weeks (P<0.001) were significantly associated with increased risk of earlier preeclampsia. Women with high SVR and normal CO (adjusted hazard ratio, 2.32 [95% CI, 1.06-5.08];P=0.035) and high SVR and low CO (adjusted hazard ratio, 7.79 [95% CI, 1.94-31.24];P=0.003) cardiovascular profiles had significantly higher risk of earlier preeclampsia compared with women with normal SVR and normal CO. The findings of this study demonstrate that hypertensive women with increased SVR and low CO had a higher risk of developing preeclampsia sooner.

Subject Keywords

Internal Medicine

URI

https://hdl.handle.net/11511/67917

Journal

HYPERTENSION

DOI

https://doi.org/10.1161/hypertensionaha.120.14982

Collections

Department of Statistics, Article

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The Prognostic Value of Angiogenic Markers in Twin Pregnancies to Predict Delivery Due to Maternal Complications of Preeclampsia Binder, Julia; Palmrich, Pilar; Pateisky, Petra; Kalafat, Erkan; Kussel, Lorenz; Zeisler, Harald; Munkhbaatar, March; Windsperger, Karin; Thilaganathan, Basky; Khalil, Asma (Ovid Technologies (Wolters Kluwer Health), 2020-07-01) The sFlt-1 (soluble fms-like tyrosine kinase-1), PlGF (placental growth factor), and their ratio are useful for predicting delivery because of preeclampsia in singleton pregnancies. Evidence on the utility of sFlt-1/PlGF ratio in twin pregnancies is lacking. We aimed to evaluate the predictive value of sFlt-1/PlGF ratio for delivery because of preeclampsia in twins. A retrospective data analysis of 164 twin pregnancies with suspected preeclampsia was performed. The sFlt-1/PlGF ratio, which was known to clin...
Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy A Systematic Review and Meta-Analysis Johnson, Sonia; Liu, Becky; Kalafat, Erkan; Thilaganathan, Basky; Khalil, Asma (Ovid Technologies (Wolters Kluwer Health), 2020-07-01) The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE,, and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women wit...
Home blood pressure monitoring in the antenatal and postpartum period: A systematic review meta-analysis Kalafat, Erkan; Benlioglu, Can; Thilaganathan, Basky; Khalil, Asma (Elsevier BV, 2020-01-01) Recent evidence suggests that home blood pressure monitoring (HBPM) is an effective way of managing women with hypertensive disorders of pregnancy (HDP) without increasing adverse outcomes. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of HBPM during pregnancy.
Prognostic value of angiogenic markers in pregnant women with chronic hypertension Binder, Julia; Palmrich, Pilar; Kalafat, Erkan; Pateisky, Petra; Oeztuerk, Ebru; Mittelberger, Johanna; Khalil, Asma (2021-09-07) Women with chronic hypertension face a 5-to 6-fold increased risk of developing preeclampsia compared with normotensive women. Angiogenic markers, especially soluble fms-like kinase 1 (sFlt-1) and placental growth factor (PlGF), were identified as clinically useful markers predicting the development of preeclampsia, but data on the prediction of superimposed preeclampsia are scarce. Therefore, we aimed to evaluate the predictive value of the sFlt-1/PlGF ratio for delivery because of superimposed preeclampsi...

Citation Formats

E. Kalafat, H. Perry, S. Bowe, B. Thilaganathan, and A. Khalil, “Prognostic Value of Maternal Cardiovascular Hemodynamics in Women With Gestational Hypertension and Chronic Hypertension in Pregnancy,” HYPERTENSION, pp. 506–513, 2020, Accessed: 00, 2020. [Online]. Available: https://hdl.handle.net/11511/67917.