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Reproductive Sciences
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Cardiac Adaptation to Pregnancy in Women with a History of Preeclampsia and a Subnormal Plasma Volume

Silvia Andrietti, MD

Department of Obstetrics and Gynecology, University Hospital Maastricht (azM), Maastricht, Netherlands, Department of Obstetrics and Gynecology, University La Sapienza, Roma, Italy

Arnold-Jan Kruse, MD, PhD

Department of Obstetrics and Gynecology, University Hospital Maastricht (azM), Maastricht, Netherlands

Sebastiaan C. A. M. Bekkers, MD, PhD

Department of Cardiology, University Hospital Maastricht (azM), Maastricht, Netherlands

Simone Sep, MSc

Department of Obstetrics and Gynecology, University Hospital Maastricht (azM), Maastricht, Netherlands

Marc Spaanderman, MD, PhD

Department of Obstetrics and Gynecology, UMC Radboud, Nijmegen, Netherlands

Louis L. H. Peeters, MD, PhD

Department of Obstetrics and Gynecology, University Hospital Maastricht (azM), Maastricht, Netherlands, lpe{at}sgyn.azm.nl.

In former preeclamptics, a subnormal plasma volume (LPV) predisposes to hemodynamic maladaptation to pregnancy. Here, we assessed the initial cardiovascular response to pregnancy in LPV (n = 20), in former preeclamptics with normal plasma volume (NPV) (n = 35) and in parous controls (CONTR) (n = 9) by echocardiography, blood pressure and heart rate (HR), before pregnancy, and by 5 and 7 weeks amenorrhea. Data analysis was by nonparametric tests. LPV differed from NPV and CONTR, by a consistently lower E/A ratio (ratio of peak mitral flow velocity in early diastole [E] and that during atrial contraction [A]) and an early-pregnancy rise in left atrial diameter (LAD). Both NPV and LPV differed from CONTR by an early-pregnancy rise in HR. The consistently lower E/A ratio together with the early-pregnancy LAD rise in LPV indicate diastolic dysfunction. The early-pregnancy rise in HR suggests sympathetic dominance in the autonomic control of the circulation.

Key Words: Preeclampsia • hemodynamics • autonomic function • plasma volume • cardiac function • echocardiography • Doppler.

This version was published on December 1, 2008

Reproductive Sciences, Vol. 15, No. 10, 1059-1065 (2008)
DOI: 10.1177/1933719108322427
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