Wang X, Lin J, Chen Y, Wong I S, Liu J, Liu F, Lau S L, Zhang Q, Xu X, Sahota D S, Lee A P W, Poon L C
Department of Obstetrics and Gynecology, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical University, Sichuan, China.
Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong SAR, China.
Ultrasound Obstet Gynecol. 2025 Sep 12. doi: 10.1002/uog.70027.
To compare the maternal hemodynamics of Chinese women at low and at high risk for preterm pre-eclampsia (PE) and assess the differences in hemodynamic parameters between high-risk women with or without prophylactic aspirin.
This was a prospective longitudinal case-control study of 857 Chinese women with a singleton pregnancy who participated in the first-trimester screen-and-prevent program for PE at the Prince of Wales Hospital, Hong Kong SAR, China, between February 2020 and March 2023. The risk of developing preterm PE (delivery before 37 weeks) was determined using the Fetal Medicine Foundation combined test (maternal factors combined with mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor). The study population comprised three groups of women: (1) women at high risk (adjusted risk ≥ 1:100) for preterm PE who received 100 mg or 160 mg of aspirin according to maternal weight (< 40 kg or ≥ 40 kg, respectively), starting before 16 weeks' gestation until 36 weeks' gestation, until delivery or until PE was diagnosed if before 36 weeks; (2) women at high risk for preterm PE who did not receive aspirin; and (3) women at low risk (adjusted risk < 1:100) for preterm PE who were matched 1:1 to high-risk women, according to maternal age, weight and date of the scan. MAP was measured using a device validated for use in pregnancy, and heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) were evaluated using two-dimensional transthoracic echocardiography at 12 + 0 to 15 + 6 weeks, 20 + 0 to 24 + 6 weeks and 30 + 0 to 37 + 6 weeks' gestation. Log transformation was applied to fit the data to a Gaussian distribution. An adjusted multilevel linear mixed-effects analysis was performed to compare the longitudinal changes of maternal hemodynamics across gestation between the three study groups.
This study comprised 389 women at low risk of preterm PE, 379 women at high risk of preterm PE who received aspirin and 89 women at high risk who did not receive aspirin. There was no significant difference in the estimated marginal mean (EMmean) of log HR across gestation among the three study groups. Compared with the low-risk group, both high-risk groups (with and without aspirin) exhibited consistently higher EMmean of log MAP and log SVR, and lower EMmean of log CO and log SV throughout gestation (all P < 0.001). Although maternal hemodynamic trajectories differed across the EMmean of log SV, CO, MAP and SVR between high-risk women with aspirin and those without, there were no significant differences in these parameters between the two high-risk groups.
This study highlights the significant differences in maternal hemodynamic adaptation during pregnancy between Chinese women at high risk and those at low risk for preterm PE. Compared with low-risk women, high-risk women exhibited increased MAP and SVR, along with reduced SV and CO as early as the first trimester, and these alterations persisted throughout gestation. Notably, aspirin prophylaxis showed a limited effect on improving maternal hemodynamics in women at high risk for preterm PE, highlighting the need for alternative strategies to address the hemodynamic maladaptation in high-risk women. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
比较中国早产子痫前期（PE）低风险和高风险女性的母体血流动力学，并评估预防性使用阿司匹林和未使用阿司匹林的高风险女性之间血流动力学参数的差异。
这是一项前瞻性纵向病例对照研究，研究对象为857名单胎妊娠的中国女性，她们于2020年2月至2023年3月期间在中国香港特别行政区威尔士亲王医院参加了孕早期PE筛查与预防项目。使用胎儿医学基金会联合检测（结合母体因素、平均动脉压（MAP）、子宫动脉搏动指数和胎盘生长因子）确定发生早产PE（孕37周前分娩）的风险。研究人群包括三组女性：（1）早产PE高风险女性（调整后风险≥1:100），根据母体体重（分别<40 kg或≥40 kg）在妊娠16周前开始至妊娠36周，直至分娩或在36周前诊断为PE时，接受100 mg或160 mg阿司匹林；（2）早产PE高风险且未接受阿司匹林的女性；（3）早产PE低风险女性（调整后风险<1:100），根据母体年龄、体重和超声扫描日期与高风险女性1:1匹配。使用经妊娠验证的设备测量MAP，并在妊娠12⁺⁰至15⁺⁶周、20⁺⁰至24⁺⁶周和30⁺⁰至37⁺⁶周时，使用二维经胸超声心动图评估心率（HR）、每搏输出量（SV）、心输出量（CO）和全身血管阻力（SVR）。对数据进行对数转换以使其符合高斯分布。进行调整后的多水平线性混合效应分析，以比较三个研究组之间妊娠期间母体血流动力学的纵向变化。
本研究包括389名早产PE低风险女性、379名接受阿司匹林的早产PE高风险女性和89名未接受阿司匹林的高风险女性。三个研究组在妊娠期间对数HR的估计边际均值（EMmean）无显著差异。与低风险组相比，两个高风险组（使用和未使用阿司匹林）在整个妊娠期间对数MAP和对数SVR的EMmean始终较高，而对数CO和对数SV的EMmean较低（均P<0.001）。尽管使用阿司匹林和未使用阿司匹林的高风险女性之间对数SV、CO、MAP和SVR的EMmean的母体血流动力学轨迹不同，但两个高风险组之间这些参数无显著差异。
本研究强调了中国早产PE高风险和低风险女性在妊娠期间母体血流动力学适应方面的显著差异。与低风险女性相比，高风险女性早在孕早期就出现MAP和SVR升高，同时SV和CO降低，且这些改变在整个妊娠期间持续存在。值得注意的是，阿司匹林预防对改善早产PE高风险女性的母体血流动力学效果有限，这突出表明需要采取替代策略来解决高风险女性的血流动力学适应不良问题。© 2025作者。《超声妇产科》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
