Early pregnancy maternal cardiovascular profiling in the prediction of hypertensive disease in pregnancy

Prediction of hypertensive disease in pregnancy re- mains challenging. Risk factor based screening util- izing history, physical characteristics, uterine artery Doppler and serum markers have been used with va- rying success. As hypertension in pregnancy appears to be associated with changes in the maternal vascu- lature, we have investigated the utility of maternal ar- terial elasticity measurement, prior to 20 weeks gesta- tion, in the prediction of hypertensive disease in preg- nancy. A HDI/Pulsewave CR2000 Research Cardio- vascular Profiling System was used to obtain radial artery pulse pressure waveforms from 623 Caucasian women at the time of their first antenatal visit. Out- come data were available in 610 cases and these com- prised the study group. The results showed that wo- men who subsequently developed gestational hypertension (n = 20) had higher baseline systolic, diastolic and pulse pressure values (though within the normal range) but similar arterial elasticity to those patients who did not develop hypertension. Women who later developed pre-eclampsia (n = 23) had, in addition, re- duced large artery elasticity and increased systemic vascular resistance compared with women who did not develop hypertension. The measurement of mater- nal radial artery elasticity in early pregnancy may pro- vide an additional refinement in screening for hyperten- sive disease, particularly pre-eclampsia, in pregnancy.