Postnatal cardiovascular morbidity following preterm pre-eclampsia: an
Objective Explore the nature of postnatal cardiovascular morbidity
following pregnancies complicated by preterm pre-eclampsia and identify
associations between pregnancy characteristics and postnatal
cardiovascular function. Design Observational sub-study of a
single-centre feasibility randomised double-blind placebo-controlled
trial. Setting Tertiary maternity hospital, UK. Population Women with
preterm pre-eclampsia, delivering <37 weeks. Methods Eligible
women underwent echocardiography, arteriography and blood pressure
monitoring <3 days, 6 weeks and 6 months postpartum.
Correlations between pregnancy and cardiovascular characteristics were
assessed using Spearman’s correlation. Main Outcome Measure Prevalence
of cardiovascular dysfunction and remodelling 6 months following preterm
pre-eclampsia. Results Forty-four women completed the study. At 6
months, 27 (61%) had diastolic dysfunction, 33 (75%) had raised total
vascular resistance (TVR) and 18 (41%) had left ventricular
remodelling. Sixteen (46%) women had de novo hypertension by 6 months
and only 2 (5%) women had a completely normal echocardiogram.
Echocardiography did not change significantly from 6 weeks to 6 months.
Earlier gestation at delivery and lower birthweight centile were
associated with worse 6-month diastolic dysfunction (E/E’: rho=-0.39,
p=0.001 & rho=-0.42, p=0.005) and TVR (rho=-0.34, p=0.02 & rho=-0.37,
p=0.01). Conclusions Preterm pre-eclampsia is associated with persistent
cardiovascular morbidity 6 months postpartum in the majority of women.
These cardiovascular changes have significant implications to long-term
cardiovascular health. The graded severity of diastolic dysfunction and
TVR with worsening pre-eclampsia phenotype suggests a dose-effect.
However, the mechanistic link remains uncertain. Funding Medical
Research Council (MR/R001693/1). Registration
https://www.clinicaltrials.gov; NCT03466333. Key words Pre-eclampsia:
clinical research; radiological imaging: ultrasound; medical disorders