Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
BJOG. 2021 Jan;128(2):167-175. doi: 10.1111/1471-0528.16269. Epub 2020 May 14.
To describe maternal haemodynamic differences in gestational hypertension with small-for-gestational-age babies (HDP + SGA), gestational hypertension with appropriate-for-gestational-age babies (HDP-only) and control pregnancies.
Prospective cohort study.
Tertiary Hospital, UK.
Women with gestational hypertension and healthy pregnant women.
Maternal haemodynamic indices were measured using a non-invasive Ultrasound Cardiac Output Monitor (USCOM-1A ) and corrected for gestational age and maternal characteristics using device-specific reference ranges.
Maternal cardiac output, stroke volume, systemic vascular resistance.
We included 114 HDP + SGA, 202 HDP-only and 401 control pregnancies at 26-41 weeks of gestation. There was no significant difference in the mean arterial blood pressure (110 versus 107 mmHg, P = 0.445) between the two HDP groups at presentation. Pregnancies complicated by HDP + SGA had significantly lower median heart rate (76 versus 85 bpm versus 83 bpm), lower cardiac output (0.85 versus 0.98 versus 0.97 MoM) and higher systemic vascular resistance (1.4 versus 1.0 versus 1.2 MoM) compared with control and HDP-only pregnancies, respectively (all P < 0.05).
Women with HDP + SGA present with more severe haemodynamic dysfunction than HDP-only. Even HDP-only pregnancies exhibit impaired haemodynamic indices compared with normal pregnancies, supporting a role of the maternal cardiovascular system in gestational hypertension irrespective of fetal size. Central haemodynamic changes may play a role in the pathogenesis of pre-eclampsia and should be considered alongside placental aetiology.
Hypertensive disorders of pregnancy are associated with worse maternal haemodynamic function when associated with small-for-gestational-age birth.
描述伴有胎儿小于胎龄儿的妊娠期高血压（HDP+SGA）、伴有适当胎龄儿的妊娠期高血压（HDP 仅）和正常妊娠孕妇之间的母体血液动力学差异。
前瞻性队列研究。
英国三级医院。
患有妊娠期高血压的孕妇和健康孕妇。
使用非侵入性超声心动图心输出量监测仪（USCOM-1A）测量母体血液动力学指标，并使用设备特定的参考范围对妊娠龄和母体特征进行校正。
母体心输出量、每搏输出量、全身血管阻力。
我们纳入了 114 例 HDP+SGA、202 例 HDP 仅和 401 例孕 26-41 周的正常妊娠孕妇。在就诊时，HDP 两组之间的平均动脉血压（110 与 107mmHg，P=0.445）无显著差异。与正常妊娠和 HDP 仅相比，HDP+SGA 妊娠的孕妇心率中位数（76 与 85bpm 与 83bpm）显著降低，心输出量中位数（0.85 与 0.98 与 0.97MoM）更低，全身血管阻力中位数（1.4 与 1.0 与 1.2MoM）更高（均 P<0.05）。
与 HDP 仅相比，HDP+SGA 的孕妇血液动力学功能障碍更为严重。即使是 HDP 仅妊娠也表现出与正常妊娠相比受损的血液动力学指数，支持母体心血管系统在妊娠期高血压中起作用，而与胎儿大小无关。中心血液动力学变化可能在子痫前期的发病机制中起作用，应与胎盘病因一起考虑。
当与胎儿小于胎龄相关时，妊娠期高血压疾病与更严重的母体血液动力学功能相关。
