loading page

Postnatal cardiovascular morbidity following preterm pre-eclampsia: an observational study.
  • +6
  • Laura Ormesher,
  • Suzanne Higson,
  • Matthew Luckie,
  • Stephen Roberts,
  • Heather Glossop,
  • Elizabeth Cottrell,
  • Andrew Trafford,
  • Edward Johnstone,
  • Jenny Myers
Laura Ormesher
The University of Manchester
Author Profile
Suzanne Higson
Manchester University NHS Foundation Trust
Author Profile
Matthew Luckie
Manchester University NHS Foundation Trust
Author Profile
Stephen Roberts
University of Manchester
Author Profile
Heather Glossop
Manchester University NHS Foundation Trust
Author Profile
Elizabeth Cottrell
The University of Manchester
Author Profile
Andrew Trafford
The University of Manchester
Author Profile
Edward Johnstone
The University of Manchester
Author Profile
Jenny Myers
The University of Manchester
Author Profile

Abstract

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 in pregnancy.