title: Maternal cardiac adaptation to subsequent pregnancy in formerly pre-eclamptic women according to recurrence of pre-eclampsia.
abstract: OBJECTIVE
  Left-ventricular remodeling in women with pre-eclampsia (PE) is concentric rather than eccentric, and tends to persist postpartum, particularly after early-onset PE. This study was designed to determine whether prepregnancy cardiac geometry and function along with cardiac adaptation to the subsequent pregnancy in former early-onset PE patients differs between those who do and those who do not develop recurrent PE later on in their second pregnancy.
  
  
  METHODS
  In 51 women with a history of early-onset PE, we performed serial cardiac ultrasound examinations and recorded automated measurements of blood pressure/heart rate before pregnancy and again at three consecutive times in the first half of their subsequent pregnancy. From the hospital records, we retrieved information on pregnancy outcome. We compared intergroup differences in cardiac indices using independent samples t-test, and intergroup differences in prepregnant cardiac ultrasound indices and subsequent pregnancy-induced cardiac adaptive response using repeated-measures ANOVA.
  
  
  RESULTS
  PE recurred in 14/51 (27%) women. Preconception, the recurrent-PE group differed from the non-recurrent-PE group by having a lower left-ventricular mass (LVM) index (28 vs 32 g/m(2.7) , P < 0.05) and stroke volume (68 vs 77 mL, P < 0.05), and a higher resting heart rate (71 vs 64 bpm, P < 0.05). Despite these prepregnancy differences, the pregnancy-induced pattern of cardiac adaptive response was comparable in the two subgroups. After excluding hypertensive women, prepregnancy values for the LVM index remained significantly lower in the recurrent-PE group.
  
  
  CONCLUSIONS
  Women with recurrent PE differed from the non-recurrent-PE group by having a lower LVM index and stroke volume, and a higher heart rate, but they responded to their subsequent pregnancy with a similar pattern of cardiac adaptation.
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Ghossein-Doha
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: M E A
authors.initials: ME
authors.lastname: Spaanderman
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Al Doulah
authors.affiliation: Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Van Kuijk
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: L L H
authors.initials: LL
authors.lastname: Peeters
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D016022:Case-Control Studies; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011247:Pregnancy; D012008:Recurrence; D013318:Stroke Volume; D014655:Vascular Resistance; D020257:Ventricular Remodeling; D055815:Young Adult
keywords: cardiac adaptation; left ventricular geometry; left ventricular mass; pre-eclampsia; recurrent pre-eclampsia