UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium (W.G., P.D., A.S.S., K.T., S.V.).
Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium (W.G., P.D.).
Hypertension. 2023 Feb;80(2):343-351. doi: 10.1161/HYPERTENSIONAHA.122.19346. Epub 2022 Sep 23.
As by definition, mean arterial pressure equals the product of cardiac output (CO) and total vascular resistance (TPR), we hypothesized that, irrespective of thresholds to define hypertension, a CO-TPR imbalance might exist in first-trimester normotensive pregnancies with altered risks for adverse gestational outcomes.
A standard protocol was used for automated blood pressure measurement combined with impedance cardiography assessment of CO and TPR (NICCOMO). First-trimester normotensive pregnant women were categorized into 3 groups relative to the reference 75th percentile (P75) of CO and TPR: (1) normal CO and TPR, (2) high CO, and (3) high TPR. These subgroups were compared at blood pressure thresholds 140/90, 130/85, and 130/80 mmHg. The gestational outcome was categorized after birth according to International Society for Studies of Hypertension in Pregnancy criteria.
Compared with pregnancies with normal CO and TPR (≤P75), women with high TPR at blood pressure <140/90 mmHg are at risk for developing gestational hypertension (odds ratio, 3.795 [1.321-10.904]; <0.010), late-onset preeclampsia (odds ratio, 3.137 [1.060-9.287]; <0.050), and neonates small for gestational age (odds ratio, 1.780 [1.056-2.998]; <0.050).
Cardiovascular imbalance can present in normotensive women in the first trimester and is associated with increased risks for adverse gestational outcomes. This study illustrates the relevance of CO and TPR assessments as an adjunct to blood pressure measurement and invites for further exploring their value in screening algorithms for gestational hypertensive disorders and/or small for gestational age.
平均动脉压等于心输出量（CO）和总血管阻力（TPR）的乘积，因此我们假设，无论高血压的定义阈值如何，在第一孕期正常血压的妊娠中可能存在 CO-TPR 失衡，并且存在改变的不良妊娠结局风险。
使用自动血压测量和阻抗心排血量评估 CO 和 TPR（NICCOMO）的标准方案。将第一孕期正常血压的孕妇分为 3 组，相对于 CO 和 TPR 的参考第 75 百分位数（P75）：（1）正常 CO 和 TPR，（2）高 CO，和（3）高 TPR。在血压阈值 140/90、130/85 和 130/80mmHg 下比较这些亚组。根据国际妊娠高血压学会标准，出生后对妊娠结局进行分类。
与正常 CO 和 TPR（≤P75）的妊娠相比，血压<140/90mmHg 时 TPR 升高的孕妇发生妊娠期高血压的风险增加（优势比，3.795 [1.321-10.904]；<0.010），晚发性子痫前期（优势比，3.137 [1.060-9.287]；<0.050）和胎儿小于胎龄（优势比，1.780 [1.056-2.998]；<0.050）。
心血管失衡可出现在第一孕期的正常血压妇女中，并与不良妊娠结局的风险增加相关。本研究表明 CO 和 TPR 评估作为血压测量的辅助手段具有相关性，并邀请进一步探索其在妊娠期高血压疾病和/或胎儿小于胎龄的筛查算法中的价值。
