Maternal Weight, Hemodynamics, and Preeclampsia

Abstract

Objectives: To evaluate the relationship between the obesity, elevated cardiac output, and the development of preeclampsia.

Methods: Maternal weight, mean arterial pressure, and cardiac output were analyzed from 9 preeclamptic, 81 gestationally hypertensive, and 89 normotensive pregnant women at 23 weeks gestation, 34 weeks gestation, and 6–8 weeks postpartum. Data were gathered prospectively and longitudinally as part of a previously described investigation. Cardiac output was measured by Doppler technique. Data were analyzed by multiple logistic regression. The data for cardiac output, weight, and mean arterial pressure were first modeled controlling for the effect of the parameter most strongly associated with preeclampsia. The data were modeled a second and third time controlling for the other two parameters.

Results: Elevated cardiac output, mean arterial pressure, and maternal weight at 23 weeks and postpartum were each associated with the development of preeclampsia. After controlling for the effects of cardiac output, neither maternal weight nor mean arterial pressure were independently associated with the development of preeclampsia. After controlling for maternal weight, elevated cardiac output remained independently associated with the development of preeclampsia.

Conclusions: Increased maternal weight and elevated cardiac output are each associated with the development of preeclampsia. While elevated cardiac output has an effect independent of maternal weight, we were unable to demonstrate that maternal weight has an independent effect. Given the association between hyperinsulinemia, obesity, hypertension, and increased cardiac output in nonpregnant patients, a potential association between hyperinsulinemia, increased cardiac output, and the development of preeclampsia deserves further investigation