title: Maternal hemodynamics at 11-13 weeks' gestation and risk of pre-eclampsia.
abstract: OBJECTIVE
  Women who develop pre-eclampsia are at increased risk of cardiovascular disease and stroke in the subsequent decades. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBP(Ao) ) and arterial stiffness, as assessed by pulse wave velocity (PWV) and augmentation index (AIx). The aim of this study was to examine the potential value of assessment of SBP(Ao) , PWV and AIx at 11-13 weeks' gestation in identifying women who subsequently develop pre-eclampsia.
  
  
  METHODS
  This was a screening study for pre-eclampsia in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Maternal history and characteristics were recorded and PWV, AIx (adjusted to a heart rate of 75 beats per min (AIx-75)) and SBP(Ao) measured. We compared these parameters in women who developed pre-eclampsia (n = 181) with those in unaffected controls (n = 6766) and examined their performance in screening for pre-eclampsia.
  
  
  RESULTS
  In the pre-eclampsia group, compared to unaffected controls, there was an increase in AIx-75 (1.13 vs. 1.00 multiples of the median (MoM); P < 0.0001), PWV (1.06 vs. 1.00 MoM; P < 0.0001) and SBP(Ao) (1.09 vs. 1.00 MoM; P < 0.0001). In screening for pre-eclampsia by a combination of maternal variables and log(10) AIx-75 MoM, log(10) PWV MoM and log(10) SBP(Ao) MoM, the estimated detection rate was 56.9% at a false-positive rate of 10%.
  
  
  CONCLUSIONS
  Compared with women who remain normotensive, women who develop pre-eclampsia have higher SBP(Ao) and arterial stiffness, which is apparent from the first trimester of pregnancy.
authors.affiliation: Department of Fetal Medicine, Institute for Women's Health, University College London Hospitals, London, UK. asmakhalil79@googlemail.com
authors.forename: A
authors.initials: A
authors.lastname: Khalil
authors.forename: R
authors.initials: R
authors.lastname: Akolekar
authors.forename: A
authors.initials: A
authors.lastname: Syngelaki
authors.forename: M
authors.initials: M
authors.lastname: Elkhouli
authors.forename: K H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D018570:Risk Assessment; D006113:United Kingdom; D059289:Vascular Stiffness