There is a strong evidence with a large cohort, proving that even in the first trimester the increased systolic blood pressure of the aorta and aortic pulse wave velocity (PWVao) could be prognostic marker for later developing pre-eclampsia, which used to occur after 20th week of the gestation. Arteriograph as a reliable method of measuring arterial stiffness could come in handy if used in daily clinical routines to screen those women with higher risk of pre-eclampsia among normotensive subjects.
Pre-eclampsia (PE) is a specific condition in women characterised by high blood pressure and signs of damage to another organ system, most often the liver and kidneys which usually begins after 20 weeks of pregnancy. These ladies are at increased risk of cardiovascular disease and stroke in their forth and further decades of their life. There are three main parameters which used for cardiovascular diagnosis, central aortic systolic blood pressure (SBPao), and pulse wave velocity (PWV) and augmentation index (AIx).
This study screened pregnant ladies those attending for their first trimester ultrasound scan at University College Hospital and King’s College Hospital in London. For measuring SBPao, PWV and AIX, Arteriograph had been used in a controlled room. based on the results, pre-eclampsia group showed an increased in their AIx, PWV & SBPao and the best of these indexes for the prediction of PE was SBPao.
Unfortunately, Most of the obstetricians perform peripheral blood pressure instead of SBPao & arterial stiffness measurements which are more valuable. Therefore, obstetricians should implement the arterial stiffness measurement in their check-up routines in their practices.
Despite the relatively high incidence of pre-eclampsia, its long-term effects are not well known. The aim of the present study was to establish the normal AIx and PWV values during and after healthy normotensive pregnancies comparing these values in patients with pre-eclampsia.
The patients’ AIx and PWV were measured with Arteriograph. The results suggest that Pre-eclampsia has a significant impact on AIx, but the changes in PWV after delivery are less pronounced. In other words, pre-eclampsia has a minor effect on arterial stiffness, which is the major contributor to PWV, but leads to significant vasoconstriction, which directly influences AIx. This finding indicates a higher cardiovascular risk in patients who have experienced early-onset pre-eclampsia.
Risk of cardiovascular diseases later in life is greater in those women who have Pre-eclampsia or gestational hypertension. Several studies have demonstrated PWV and AIx to be reliable parameters with cardiovascular prognostic values. In this study the correlation between arterial status and severity of hypertensive disorder of pregnancy (HDP) along with other clinical pictures such as prevalence of small for gestational age (SGA) has been aimed.
Women with preeclampsia or gestational hypertension were divided into two groups: those who had a small for gestational age neonate (HDP with SGA) and those with an appropriately grown neonate. Using Arteriograph, both PWV and AIx were measured from the pressure waveform.
Results showed that the women with HDP have significantly higher aortic PWV and AIx compared to normotensive women. Furthermore, HDP subjects with SGA had significantly higher adjustable brachial and aortic AIx.
Concluded from the study, SGA neonate in preeclampsia is likely to be a consequence of placental hypoperfusion secondary to lower cardiac output and high vascular resistance. Therefore, measuring AIx could help identifying those who are the most at risk of SGA and later life cardiovascular disease.