Division of Experimental Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
Metabolism. 2021 Jul;120:154794. doi: 10.1016/j.metabol.2021.154794. Epub 2021 May 8.
Preeclampsia (PrE) is a leading complication of pregnancy characterized by vascular dysfunction. Characterizing the longitudinal changes in vascular function prior to PrE onset is critical to the identification of optimal timepoints for vascular assessment and the development of effective early screening strategies.
In this prospective longitudinal study of women with singleton high-risk pregnancies, arterial stiffness and wave reflection parameters were assessed using applanation tonometry at 10-13 weeks' gestation and repeated every 4 weeks throughout pregnancy. Changepoints in carotid-femoral pulse wave velocity (cfPWV), carotid-radial PWV (crPWV), augmentation index (AIx), time to wave reflection (T), pulse pressure amplification (PPA), and subendocardial viability ratio (SEVR) were compared between women who did and did not subsequently develop PrE.
A changepoint in cfPWV and crPWV was detected at 14-17 weeks' gestation. cfPWV then increased in women who went on to develop PrE but decreased in women who did not; a 1.2 m/s difference in cfPWV between the groups was observed at 22-25 weeks' gestation. Conversely, crPWV converged in the two groups from a baseline difference of 1.05 m/s (95% credible interval: 0.37, 1.72). Women who subsequently developed PrE demonstrated an increase in AIx at 18-21 weeks' gestation that was not seen in women who did not develop PrE until 30-33 weeks. No differences in T, PPA, or SEVR were observed between the groups.
Altered vascular adaptations were detected using measures of arterial stiffness and wave reflection in the early second trimester of pregnant women who developed PrE compared to those who did not. These findings demonstrate the potential clinical utility of arterial stiffness and wave reflection parameters as an early screening tool for PrE, which can be used to inform clinical management of high-risk pregnancies.
子痫前期（PrE）是一种主要的妊娠并发症，其特征为血管功能障碍。在 PrE 发病前，描述血管功能的纵向变化对于确定血管评估的最佳时间点以及开发有效的早期筛查策略至关重要。
在这项对患有单胎高危妊娠的女性进行的前瞻性纵向研究中，使用平板张力计在 10-13 周妊娠时评估动脉僵硬度和波反射参数，并在整个妊娠期间每 4 周重复一次。比较了随后发生 PrE 的女性与未发生 PrE 的女性之间颈动脉-股动脉脉搏波速度（cfPWV）、颈动脉-桡动脉脉搏波速度（crPWV）、增强指数（AIx）、波反射时间（T）、脉搏压放大率（PPA）和心内膜下活力比（SEVR）的变化点。
在 14-17 周妊娠时检测到 cfPWV 和 crPWV 的变化点。随后发生 PrE 的女性的 cfPWV 增加，而未发生 PrE 的女性的 cfPWV 减少；在 22-25 周妊娠时，两组之间的 cfPWV 差异为 1.2 m/s。相反，从基线差异 1.05 m/s（95%可信区间：0.37，1.72）开始，两组的 crPWV 逐渐趋同。随后发生 PrE 的女性在 18-21 周妊娠时 AIx 增加，而未发生 PrE 的女性直到 30-33 周妊娠时才出现这种情况。两组之间的 T、PPA 或 SEVR 无差异。
与未发生 PrE 的女性相比，发生 PrE 的孕妇在妊娠中期早期使用动脉僵硬度和波反射测量发现了血管适应性改变。这些发现表明动脉僵硬度和波反射参数作为 PrE 的早期筛查工具具有潜在的临床应用价值，可用于为高危妊娠的临床管理提供信息。
