Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark.
Department of Obstetrics Copenhagen University Hospital Herlev Denmark.
J Am Heart Assoc. 2024 Oct 15;13(20):e032673. doi: 10.1161/JAHA.123.032673. Epub 2024 Oct 11.
Whether cardiovascular dysfunction is associated with preeclampsia in women without fetal growth restriction (FGR) is unclear. Our objective was to investigate associations between third-trimester cardiac output (CO) and systemic vascular resistance and risk of hypertensive disorders of pregnancy in women with and without FGR.
A case-cohort study in 906 pregnant women in Denmark with repeated third-trimester cardiac function assessments was performed using the Ultrasound Cardiac Output Monitor 1A. Using Cox regression, we compared rates of hypertensive disorders of pregnancy in women with low, normal, and high CO and normal and high systemic vascular resistance, by FGR status and gestational age, and evaluated associations between a third-trimester drop in CO or increase in systemic vascular resistance and preeclampsia risk in women without FGR. The analysis included 249 women with preeclampsia (42 with FGR) and 119 women with gestational hypertension. Low CO was strongly associated with preeclampsia at <37 weeks (women with FGR: hazard ratio [HR], 5.25 [95% CI, 1.26-21.9]; women without FGR: HR, 2.19 [95% CI, 1.07-4.48]). Our results also suggested an association between low CO and preeclampsia at ≥37 weeks among women without FGR (HR, 1.31 [95% CI, 0.84-2.03]), and between a third-trimester drop in CO >75th percentile and preeclampsia in women without FGR (odds ratio, 1.91 [95% CI, 0.84-4.36]). High systemic vascular resistance was strongly associated with increased rates of all forms of hypertensive disorders of pregnancy.
Low CO is associated with preeclampsia risk in women with and without FGR, particularly before 37 weeks. Repeated measurements of third-trimester cardiovascular function might identify women without FGR for monitoring for preeclampsia, but this result needs to be confirmed in other studies.
心血管功能障碍是否与无胎儿生长受限（FGR）的子痫前期妇女有关尚不清楚。我们的目的是研究孕晚期心输出量（CO）和全身血管阻力与伴有和不伴有 FGR 的子痫前期风险之间的关系。
在丹麦进行了一项 906 例孕妇的病例-队列研究，使用 Ultrasound Cardiac Output Monitor 1A 进行了多次孕晚期心功能评估。采用 Cox 回归，我们按 FGR 状态和孕龄比较了 CO 低、正常和高以及全身血管阻力正常和高的孕妇中高血压疾病的发生率，并评估了孕晚期 CO 下降或全身血管阻力增加与无 FGR 的子痫前期风险之间的关系。分析包括 249 例子痫前期患者（42 例 FGR）和 119 例妊娠期高血压患者。CO 低与 <37 周的子痫前期密切相关（伴有 FGR：风险比[HR]，5.25[95%CI，1.26-21.9]；不伴有 FGR：HR，2.19[95%CI，1.07-4.48]）。我们的结果还表明，不伴有 FGR 的妇女在≥37 周时 CO 低与子痫前期之间存在关联（HR，1.31[95%CI，0.84-2.03]），孕晚期 CO 下降>75%与不伴有 FGR 的子痫前期之间存在关联（比值比，1.91[95%CI，0.84-4.36]）。高全身血管阻力与所有形式的高血压疾病的发生率增加密切相关。
CO 低与伴有和不伴有 FGR 的子痫前期妇女的子痫前期风险相关，尤其是在 37 周之前。重复测量孕晚期心血管功能可能会识别出不伴有 FGR 的子痫前期高危妇女，但这一结果需要在其他研究中得到证实。
