title: Early pregnancy circulatory adaptation and recurrent hypertensive disease: an explorative study.
abstract: BACKGROUND
  Hypertensive pregnancy disorders are assumed to be preceded by defective spiral artery remodeling. Whether this localized aberration at the implantation site affects the initial maternal systemic cardiovascular and renal adaptation to pregnancy is unclear. We explored in a high-risk population, whether the initial systemic maternal adaptation to pregnancy differs between women who do and do not develop a recurrent hypertensive disorder later on in pregnancy.
  
  
  METHODS
  We enrolled 61 normotensive women with a previous hypertensive disorder of pregnancy and subdivided them into 2 subgroups, based on whether or not their next pregnancy remained uneventful (n = 33) or became complicated by a recurrent hypertensive disorder (n = 28). We measured before pregnancy and again at 18 ± 2 weeks of gestation cardiac output, blood pressure, plasma volume, creatinine clearance, and calculated total peripheral vascular resistance from cardiac output and blood pressure.
  
  
  RESULTS
  Both subgroups responded to pregnancy with an increase in cardiac output, plasma volume, heart rate, and creatinine clearance, and a decrease in blood pressure and total peripheral vascular resistance. Women who developed a recurrent hypertensive disorder differed from their counterparts with an uneventful next pregnancy by smaller pregnancy-induced increases in creatinine clearance (19% vs. 31%, P = .035) and cardiac output (10% vs. 20%, P = .035), respectively.
  
  
  CONCLUSIONS
  The initial systemic cardiovascular and renal adaptations to pregnancy in women who develop a recurrent gestational hypertensive disorder differ from those in their counterparts with an uneventful next pregnancy by smaller rises in creatinine clearance and cardiac output.
authors: Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands. v.lopesvanbalen@gmail.com
authors: V A
authors: VA
authors: Lopes van Balen
authors: J J
authors: JJ
authors: Spaan
authors: C
authors: C
authors: Ghossein
authors: S M J
authors: SM
authors: van Kuijk
authors: M E A
authors: ME
authors: Spaanderman
authors: L L H
authors: LL
authors: Peeters
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002302:Cardiac Output; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D005865:Gestational Age; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology; D010953:Plasma Volume; D011247:Pregnancy; D012008:Recurrence; D012307:Risk Factors; D014655:Vascular Resistance; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: cardiac ultrasound; gestational hypertension; maternal adaptation to pregnancy; plasma volume; preeclampsia; renal function