TY - JOUR
T1 - The effect of parity on longitudinal maternal hemodynamics
AU - Ling, Hua Zen
AU - Guy, Gavin
AU - Bisquera, Alessandra
AU - Poon, Liona C
AU - Nicolaides, Kypros H
AU - Kametas, Nikos A
N1 - Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - BACKGROUND: Parous women have a lower risk for pregnancy complications, such as preeclampsia (PE) or delivery of small for gestational age (SGA) neonates. However, parous women are a heterogeneous group of patients as they contain a low-risk cohort with previously uncomplicated pregnancies and a high-risk cohort with previous pregnancies complicated by PE and / or SGA. Previous studies examining the effect of parity on maternal hemodynamics, including cardiac output (CO) and peripheral vascular resistance (PVR), did not distinguish between parous women with and without a history of PE or SGA and reported contradictory results.OBJECTIVES: To compare maternal hemodynamics, in nulliparous women and in parous women with and without previous PE and / or SGA.STUDY DESIGN: This was a prospective, longitudinal study of maternal hemodynamics, assessed by a bioreactance method, measured at 11+0-13+6, 19+0-24+0, 30+0-34+0 and 35+0-37+0 weeks' gestation in three groups of women. Group 1 was composed of parous women without history of PE and / or SGA (n=632), Group 2 was of nulliparous women (n=829) and Group 3 was composed of parous women with history of PE and / or SGA (n=113). Multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal characteristics, medical history, and development of PE or SGA in the current pregnancy.RESULTS: In groups 1 and 2, CO increased with gestational age to a peak at 32 weeks and PVR showed a reversed pattern with its nadir at 32 weeks; in group 1, compared to group 2, there was better cardiac adaptation, reflected in higher CO and lower PVR. In group 3 there was a hyperdynamic profile of higher CO and lower PVR at first trimester followed by an earlier sharp decline of CO and increase of PVR from mid-gestation. The incidence of PE and SGA was highest in group 3 and lowest in group1.CONCLUSION: There are parity-specific differences in maternal cardiac adaptation in pregnancy.
AB - BACKGROUND: Parous women have a lower risk for pregnancy complications, such as preeclampsia (PE) or delivery of small for gestational age (SGA) neonates. However, parous women are a heterogeneous group of patients as they contain a low-risk cohort with previously uncomplicated pregnancies and a high-risk cohort with previous pregnancies complicated by PE and / or SGA. Previous studies examining the effect of parity on maternal hemodynamics, including cardiac output (CO) and peripheral vascular resistance (PVR), did not distinguish between parous women with and without a history of PE or SGA and reported contradictory results.OBJECTIVES: To compare maternal hemodynamics, in nulliparous women and in parous women with and without previous PE and / or SGA.STUDY DESIGN: This was a prospective, longitudinal study of maternal hemodynamics, assessed by a bioreactance method, measured at 11+0-13+6, 19+0-24+0, 30+0-34+0 and 35+0-37+0 weeks' gestation in three groups of women. Group 1 was composed of parous women without history of PE and / or SGA (n=632), Group 2 was of nulliparous women (n=829) and Group 3 was composed of parous women with history of PE and / or SGA (n=113). Multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal characteristics, medical history, and development of PE or SGA in the current pregnancy.RESULTS: In groups 1 and 2, CO increased with gestational age to a peak at 32 weeks and PVR showed a reversed pattern with its nadir at 32 weeks; in group 1, compared to group 2, there was better cardiac adaptation, reflected in higher CO and lower PVR. In group 3 there was a hyperdynamic profile of higher CO and lower PVR at first trimester followed by an earlier sharp decline of CO and increase of PVR from mid-gestation. The incidence of PE and SGA was highest in group 3 and lowest in group1.CONCLUSION: There are parity-specific differences in maternal cardiac adaptation in pregnancy.
KW - bioreactance
KW - cardiac output
KW - fetal growth restriction
KW - hemodynamics
KW - nulliparous
KW - parity
KW - parous
KW - peripheral vascular resistance
KW - placental insufficiency
KW - preeclampsia
KW - pregnancy
KW - small for gestational age
UR - http://www.scopus.com/inward/record.url?scp=85065624300&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2019.03.027
DO - 10.1016/j.ajog.2019.03.027
M3 - Article
C2 - 30951684
SN - 0002-9378
VL - 221
SP - 249.e1-249.e14
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
IS - 3
ER -