Maternal hemodynamics in screen‐positive and screen‐negative women of the ASPRE trial
ABSTRACT Objective To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre‐eclampsia (PE) or deliver a small‐for‐gestational‐age (SGA) neonate, between those identified at 11–13 weeks' gestation as being screen positive or negative for preterm PE, by a com...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2019-07, Vol.54 (1), p.51-57 |
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| creator | Ling, H. Z. Guy, G. P. Bisquera, A. Poon, L. C. Nicolaides, K. H. Kametas, N. A. |
| description | ABSTRACT
Objective
To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre‐eclampsia (PE) or deliver a small‐for‐gestational‐age (SGA) neonate, between those identified at 11–13 weeks' gestation as being screen positive or negative for preterm PE, by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and pregnancy associated plasma protein‐A.
Methods
This was a prospective longitudinal cohort study of maternal cardiovascular function, assessed using a bioreactance method, in women undergoing first‐trimester screening for PE. Maternal hemodynamics and perinatal outcome were compared between screen‐positive and screen‐negative women who did not have a medical comorbidity, did not develop PE or pregnancy‐induced hypertension and delivered at term a live neonate with birth weight between the 5th and 95th percentiles. A multilevel linear mixed‐effects model was used to compare the repeated measures of cardiac variables, controlling for maternal characteristics.
Results
The screen‐negative group (n = 926) had normal cardiac function changes across gestation, whereas the screen‐positive group (n = 170) demonstrated static or reduced cardiac output and stroke volume and higher mean arterial pressure and peripheral vascular resistance with advancing gestation. In the screen‐positive group, compared with screen‐negative women, birth‐weight Z‐score was shifted toward lower values, with prevalence of delivery of a neonate below the 35th, 30th or 25th percentile being about 70% higher, and the rate of operative delivery for fetal distress in labor also being higher.
Conclusion
Women who were screen positive for impaired placentation, even though they did not develop PE or deliver a SGA neonate, had pathological cardiac adaptation in pregnancy and increased risk of adverse perinatal outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. |
| doi_str_mv | 10.1002/uog.20125 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2111746114</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2111746114</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3885-d71cb7047b6b48237223901102cf0efad686f88aff22b85a4e433a228aa3f69b3</originalsourceid><addsrcrecordid>eNp10M1Kw0AUBeBBFK0_C19AAm50kXrnzmSSLEX8g0pF7cJVmCR3NJJkaiZRuvMRfEafxNRWBcHVhcPHgXsY2-Uw5AB41NmHIQLHYIUNuFSxDyEEq2wAsQI_VDFusE3nngBASaHW2YYAlEqgGrD7K91SU-vSe6TK5rNaV0XmvKL2XNYQ1R9v71PrirZ4IU_X-W9a04P-Sl9tRbVnjdc-knd8e31z6rVNoctttmZ06WhnebfY5Oz07uTCH43PL0-OR34moijw85BnaQgyTFUqIxQhooiBc8DMABmdq0iZKNLGIKZRoCVJITRipLUwKk7FFjtY9E4b-9yRa5OqcBmVpa7Jdi5BznkoFeeyp_t_6JPt5s_3CoNYIBdc9OpwobLGOteQSaZNUelmlnBI5nsn_d7J19693Vs2dmlF-Y_8HrgHRwvwWpQ0-78pmYzPF5WfXP-KTg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2259321313</pqid></control><display><type>article</type><title>Maternal hemodynamics in screen‐positive and screen‐negative women of the ASPRE trial</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Ling, H. Z. ; Guy, G. P. ; Bisquera, A. ; Poon, L. C. ; Nicolaides, K. H. ; Kametas, N. A.</creator><creatorcontrib>Ling, H. Z. ; Guy, G. P. ; Bisquera, A. ; Poon, L. C. ; Nicolaides, K. H. ; Kametas, N. A.</creatorcontrib><description>ABSTRACT
Objective
To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre‐eclampsia (PE) or deliver a small‐for‐gestational‐age (SGA) neonate, between those identified at 11–13 weeks' gestation as being screen positive or negative for preterm PE, by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and pregnancy associated plasma protein‐A.
Methods
This was a prospective longitudinal cohort study of maternal cardiovascular function, assessed using a bioreactance method, in women undergoing first‐trimester screening for PE. Maternal hemodynamics and perinatal outcome were compared between screen‐positive and screen‐negative women who did not have a medical comorbidity, did not develop PE or pregnancy‐induced hypertension and delivered at term a live neonate with birth weight between the 5th and 95th percentiles. A multilevel linear mixed‐effects model was used to compare the repeated measures of cardiac variables, controlling for maternal characteristics.
Results
The screen‐negative group (n = 926) had normal cardiac function changes across gestation, whereas the screen‐positive group (n = 170) demonstrated static or reduced cardiac output and stroke volume and higher mean arterial pressure and peripheral vascular resistance with advancing gestation. In the screen‐positive group, compared with screen‐negative women, birth‐weight Z‐score was shifted toward lower values, with prevalence of delivery of a neonate below the 35th, 30th or 25th percentile being about 70% higher, and the rate of operative delivery for fetal distress in labor also being higher.
Conclusion
Women who were screen positive for impaired placentation, even though they did not develop PE or deliver a SGA neonate, had pathological cardiac adaptation in pregnancy and increased risk of adverse perinatal outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.20125</identifier><identifier>PMID: 30246326</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; Arterial Pressure - physiology ; bioreactance ; Birth weight ; Birth Weight - physiology ; Blood pressure ; Cardiac output ; Cardiac Output - physiology ; Cardiovascular system ; Female ; Fetal Distress - surgery ; fetal growth restriction ; Fetal Growth Retardation - diagnosis ; Fetal Growth Retardation - physiopathology ; Fetuses ; Gestation ; Growth factors ; Heart ; hemodynamic ; Hemodynamics ; Hemodynamics - physiology ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced - physiopathology ; Infant, Newborn ; Longitudinal Studies ; Perinatal Mortality - trends ; peripheral vascular resistance ; Placenta ; Placenta Growth Factor - metabolism ; placental insufficiency ; Pre-Eclampsia - diagnosis ; Pre-Eclampsia - physiopathology ; Preeclampsia ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, First - metabolism ; Pregnancy Trimester, First - physiology ; Pregnancy-Associated Plasma Protein-A - metabolism ; pre‐eclampsia screening ; Prospective Studies ; Pulsatile Flow - physiology ; Small-for-gestational age ; Stroke ; Stroke volume ; Uterine Artery - diagnostic imaging ; Uterus ; Vascular Resistance - physiology ; Weight ; Womens health</subject><ispartof>Ultrasound in obstetrics & gynecology, 2019-07, Vol.54 (1), p.51-57</ispartof><rights>Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3885-d71cb7047b6b48237223901102cf0efad686f88aff22b85a4e433a228aa3f69b3</citedby><cites>FETCH-LOGICAL-c3885-d71cb7047b6b48237223901102cf0efad686f88aff22b85a4e433a228aa3f69b3</cites><orcidid>0000-0002-3944-4130 ; 0000-0002-7992-6038</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.20125$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.20125$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30246326$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ling, H. Z.</creatorcontrib><creatorcontrib>Guy, G. P.</creatorcontrib><creatorcontrib>Bisquera, A.</creatorcontrib><creatorcontrib>Poon, L. C.</creatorcontrib><creatorcontrib>Nicolaides, K. H.</creatorcontrib><creatorcontrib>Kametas, N. A.</creatorcontrib><title>Maternal hemodynamics in screen‐positive and screen‐negative women of the ASPRE trial</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>ABSTRACT
Objective
To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre‐eclampsia (PE) or deliver a small‐for‐gestational‐age (SGA) neonate, between those identified at 11–13 weeks' gestation as being screen positive or negative for preterm PE, by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and pregnancy associated plasma protein‐A.
Methods
This was a prospective longitudinal cohort study of maternal cardiovascular function, assessed using a bioreactance method, in women undergoing first‐trimester screening for PE. Maternal hemodynamics and perinatal outcome were compared between screen‐positive and screen‐negative women who did not have a medical comorbidity, did not develop PE or pregnancy‐induced hypertension and delivered at term a live neonate with birth weight between the 5th and 95th percentiles. A multilevel linear mixed‐effects model was used to compare the repeated measures of cardiac variables, controlling for maternal characteristics.
Results
The screen‐negative group (n = 926) had normal cardiac function changes across gestation, whereas the screen‐positive group (n = 170) demonstrated static or reduced cardiac output and stroke volume and higher mean arterial pressure and peripheral vascular resistance with advancing gestation. In the screen‐positive group, compared with screen‐negative women, birth‐weight Z‐score was shifted toward lower values, with prevalence of delivery of a neonate below the 35th, 30th or 25th percentile being about 70% higher, and the rate of operative delivery for fetal distress in labor also being higher.
Conclusion
Women who were screen positive for impaired placentation, even though they did not develop PE or deliver a SGA neonate, had pathological cardiac adaptation in pregnancy and increased risk of adverse perinatal outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</description><subject>Adult</subject><subject>Arterial Pressure - physiology</subject><subject>bioreactance</subject><subject>Birth weight</subject><subject>Birth Weight - physiology</subject><subject>Blood pressure</subject><subject>Cardiac output</subject><subject>Cardiac Output - physiology</subject><subject>Cardiovascular system</subject><subject>Female</subject><subject>Fetal Distress - surgery</subject><subject>fetal growth restriction</subject><subject>Fetal Growth Retardation - diagnosis</subject><subject>Fetal Growth Retardation - physiopathology</subject><subject>Fetuses</subject><subject>Gestation</subject><subject>Growth factors</subject><subject>Heart</subject><subject>hemodynamic</subject><subject>Hemodynamics</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension, Pregnancy-Induced - physiopathology</subject><subject>Infant, Newborn</subject><subject>Longitudinal Studies</subject><subject>Perinatal Mortality - trends</subject><subject>peripheral vascular resistance</subject><subject>Placenta</subject><subject>Placenta Growth Factor - metabolism</subject><subject>placental insufficiency</subject><subject>Pre-Eclampsia - diagnosis</subject><subject>Pre-Eclampsia - physiopathology</subject><subject>Preeclampsia</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Pregnancy Trimester, First - metabolism</subject><subject>Pregnancy Trimester, First - physiology</subject><subject>Pregnancy-Associated Plasma Protein-A - metabolism</subject><subject>pre‐eclampsia screening</subject><subject>Prospective Studies</subject><subject>Pulsatile Flow - physiology</subject><subject>Small-for-gestational age</subject><subject>Stroke</subject><subject>Stroke volume</subject><subject>Uterine Artery - diagnostic imaging</subject><subject>Uterus</subject><subject>Vascular Resistance - physiology</subject><subject>Weight</subject><subject>Womens health</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10M1Kw0AUBeBBFK0_C19AAm50kXrnzmSSLEX8g0pF7cJVmCR3NJJkaiZRuvMRfEafxNRWBcHVhcPHgXsY2-Uw5AB41NmHIQLHYIUNuFSxDyEEq2wAsQI_VDFusE3nngBASaHW2YYAlEqgGrD7K91SU-vSe6TK5rNaV0XmvKL2XNYQ1R9v71PrirZ4IU_X-W9a04P-Sl9tRbVnjdc-knd8e31z6rVNoctttmZ06WhnebfY5Oz07uTCH43PL0-OR34moijw85BnaQgyTFUqIxQhooiBc8DMABmdq0iZKNLGIKZRoCVJITRipLUwKk7FFjtY9E4b-9yRa5OqcBmVpa7Jdi5BznkoFeeyp_t_6JPt5s_3CoNYIBdc9OpwobLGOteQSaZNUelmlnBI5nsn_d7J19693Vs2dmlF-Y_8HrgHRwvwWpQ0-78pmYzPF5WfXP-KTg</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Ling, H. Z.</creator><creator>Guy, G. P.</creator><creator>Bisquera, A.</creator><creator>Poon, L. C.</creator><creator>Nicolaides, K. H.</creator><creator>Kametas, N. A.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3944-4130</orcidid><orcidid>https://orcid.org/0000-0002-7992-6038</orcidid></search><sort><creationdate>201907</creationdate><title>Maternal hemodynamics in screen‐positive and screen‐negative women of the ASPRE trial</title><author>Ling, H. Z. ; Guy, G. P. ; Bisquera, A. ; Poon, L. C. ; Nicolaides, K. H. ; Kametas, N. A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3885-d71cb7047b6b48237223901102cf0efad686f88aff22b85a4e433a228aa3f69b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Arterial Pressure - physiology</topic><topic>bioreactance</topic><topic>Birth weight</topic><topic>Birth Weight - physiology</topic><topic>Blood pressure</topic><topic>Cardiac output</topic><topic>Cardiac Output - physiology</topic><topic>Cardiovascular system</topic><topic>Female</topic><topic>Fetal Distress - surgery</topic><topic>fetal growth restriction</topic><topic>Fetal Growth Retardation - diagnosis</topic><topic>Fetal Growth Retardation - physiopathology</topic><topic>Fetuses</topic><topic>Gestation</topic><topic>Growth factors</topic><topic>Heart</topic><topic>hemodynamic</topic><topic>Hemodynamics</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension, Pregnancy-Induced - physiopathology</topic><topic>Infant, Newborn</topic><topic>Longitudinal Studies</topic><topic>Perinatal Mortality - trends</topic><topic>peripheral vascular resistance</topic><topic>Placenta</topic><topic>Placenta Growth Factor - metabolism</topic><topic>placental insufficiency</topic><topic>Pre-Eclampsia - diagnosis</topic><topic>Pre-Eclampsia - physiopathology</topic><topic>Preeclampsia</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Pregnancy Trimester, First - metabolism</topic><topic>Pregnancy Trimester, First - physiology</topic><topic>Pregnancy-Associated Plasma Protein-A - metabolism</topic><topic>pre‐eclampsia screening</topic><topic>Prospective Studies</topic><topic>Pulsatile Flow - physiology</topic><topic>Small-for-gestational age</topic><topic>Stroke</topic><topic>Stroke volume</topic><topic>Uterine Artery - diagnostic imaging</topic><topic>Uterus</topic><topic>Vascular Resistance - physiology</topic><topic>Weight</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ling, H. Z.</creatorcontrib><creatorcontrib>Guy, G. P.</creatorcontrib><creatorcontrib>Bisquera, A.</creatorcontrib><creatorcontrib>Poon, L. C.</creatorcontrib><creatorcontrib>Nicolaides, K. H.</creatorcontrib><creatorcontrib>Kametas, N. A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ling, H. Z.</au><au>Guy, G. P.</au><au>Bisquera, A.</au><au>Poon, L. C.</au><au>Nicolaides, K. H.</au><au>Kametas, N. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Maternal hemodynamics in screen‐positive and screen‐negative women of the ASPRE trial</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2019-07</date><risdate>2019</risdate><volume>54</volume><issue>1</issue><spage>51</spage><epage>57</epage><pages>51-57</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><abstract>ABSTRACT
Objective
To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre‐eclampsia (PE) or deliver a small‐for‐gestational‐age (SGA) neonate, between those identified at 11–13 weeks' gestation as being screen positive or negative for preterm PE, by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and pregnancy associated plasma protein‐A.
Methods
This was a prospective longitudinal cohort study of maternal cardiovascular function, assessed using a bioreactance method, in women undergoing first‐trimester screening for PE. Maternal hemodynamics and perinatal outcome were compared between screen‐positive and screen‐negative women who did not have a medical comorbidity, did not develop PE or pregnancy‐induced hypertension and delivered at term a live neonate with birth weight between the 5th and 95th percentiles. A multilevel linear mixed‐effects model was used to compare the repeated measures of cardiac variables, controlling for maternal characteristics.
Results
The screen‐negative group (n = 926) had normal cardiac function changes across gestation, whereas the screen‐positive group (n = 170) demonstrated static or reduced cardiac output and stroke volume and higher mean arterial pressure and peripheral vascular resistance with advancing gestation. In the screen‐positive group, compared with screen‐negative women, birth‐weight Z‐score was shifted toward lower values, with prevalence of delivery of a neonate below the 35th, 30th or 25th percentile being about 70% higher, and the rate of operative delivery for fetal distress in labor also being higher.
Conclusion
Women who were screen positive for impaired placentation, even though they did not develop PE or deliver a SGA neonate, had pathological cardiac adaptation in pregnancy and increased risk of adverse perinatal outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30246326</pmid><doi>10.1002/uog.20125</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3944-4130</orcidid><orcidid>https://orcid.org/0000-0002-7992-6038</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Arterial Pressure - physiology bioreactance Birth weight Birth Weight - physiology Blood pressure Cardiac output Cardiac Output - physiology Cardiovascular system Female Fetal Distress - surgery fetal growth restriction Fetal Growth Retardation - diagnosis Fetal Growth Retardation - physiopathology Fetuses Gestation Growth factors Heart hemodynamic Hemodynamics Hemodynamics - physiology Humans Hypertension Hypertension, Pregnancy-Induced - physiopathology Infant, Newborn Longitudinal Studies Perinatal Mortality - trends peripheral vascular resistance Placenta Placenta Growth Factor - metabolism placental insufficiency Pre-Eclampsia - diagnosis Pre-Eclampsia - physiopathology Preeclampsia Pregnancy Pregnancy Outcome Pregnancy Trimester, First - metabolism Pregnancy Trimester, First - physiology Pregnancy-Associated Plasma Protein-A - metabolism pre‐eclampsia screening Prospective Studies Pulsatile Flow - physiology Small-for-gestational age Stroke Stroke volume Uterine Artery - diagnostic imaging Uterus Vascular Resistance - physiology Weight Womens health |
| title | Maternal hemodynamics in screen‐positive and screen‐negative women of the ASPRE trial |
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