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The effect of parity on longitudinal maternal hemodynamics

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)249.e1-249.e14
JournalAmerican Journal of Obstetrics and Gynecology
Volume221
Issue number3
Early online date2 Apr 2019
DOIs
Publication statusPublished - 1 Sep 2019

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Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.

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Abstract

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.

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