Low plasma volume following pregnancy complicated by pre-eclampsia predisposes for hypertensive disease in a next pregnancy.
OBJECTIVE
A large number of women with a history of pre-eclampsia/HELLP have a low plasma volume at least six months postpartum. The objective of this study was to determine whether a low plasma volume in formerly pre-eclamptic women and HELLP patients is associated with an increased risk for recurrent hypertensive complications in a next pregnancy.


METHODS
Prospective observational study.


METHODS
Tertiary obstetric centre.


METHODS
Formerly pre-eclamptic women and controls.


METHODS
In 316 women with a history of pre-eclampsia and/or HELLP, we measured, plasma volume along with haemodynamic, metabolic and haemostatic variables at least six months postpartum. A group of 22 healthy parous controls was used as a reference. After standardising plasma volume for body mass index, women were subdivided into normotensive and normal plasma volume (n = 199), normotensive and low plasma volume (n = 76) and hypertensive (n = 41) subgroups, which were compared for demography, clinical parameters and course of a next pregnancy.


METHODS
Recurrent hypertensive disease of pregnancy.


RESULTS
Relative to the normal plasma volume subgroup, normotensive women in the low plasma volume subgroup have a higher body mass index, a lower total vascular compliance and a shorter estimated systemic circulation time. They have a higher HOMA index and higher fasting triglyceride levels. In normotensive and hypertensive former patients alike, low plasma volume is associated with a higher recurrence of hypertensive complications in a next pregnancy compared with normotensive women with normal plasma volume.


CONCLUSIONS
Low plasma volume in normotensive women with a history of pre-eclampsia and/or HELLP is associated with overweight, reduced vascular compliance and insulin resistance and a predisposition for recurrent pre-eclampsia and HELLP syndrome in a next pregnancy.
Department of Obstetrics and Gynaecology, University Maastricht, The Netherlands.
Robert
R
Aardenburg
Marc E A
ME
Spaanderman
Timo H
TH
Ekhart
Hugo W
HW
van Eijndhoven
Olivier W H
OW
van der Heijden
Louis L H
LL
Peeters
D000328:Adult; D005260:Female; D017359:HELLP Syndrome / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D010298:Parity; D010953:Plasma Volume / Q000502:physiology*; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology*; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis