Pressor response to cycle ergometry in the midtrimester of pregnancy: can it predict preeclampsia?

Ninety-seven primigravid patients were prospectively studied to assess the predictive value of the pressor response to aerobic exercise as a screening test for preeclampsia. The blood pressure response to cycle ergometry exercise to a maternal pulse of 140 beats/min was recorded on each subject. Each subject was studied in the second trimester of pregnancy at a mean gestational age of 23 weeks (range, 18 to 27). Three of the study subjects developed hypertension with proteinuria in the third trimester. A rise in systolic blood pressure of at least 30 mm Hg occurred in 29 patients, but this did not predict third trimester preeclampsia (p = 0.21). A rise in diastolic blood pressure of 20 mm was observed in 18 patients, two of whom developed preeclampsia (p = 0.08). An increase of diastolic pressure of 20 mm Hg with moderate cycle ergometry exercise in the second trimester may predict a subset of patients at elevated risk of preeclampsia in the third trimester. However, the positive predictive value of this 20 mm Hg pressor increase (11%) limits its applicability as a screening test. Thus, we cannot recommend the use of an exercise screening test at this time.