Cardiovascular function in women with recurrent miscarriage, pre-eclampsia and/or intrauterine growth restriction

Abstract

Objective: To investigate prepregnancy cardiovascular function and risk factors in women with previous pregnancy complications. Methods: Thirty-four women with previous normal pregnancy (controls), 26 with unexplained recurrent miscarriage (RM) and 14 with pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR), planning to conceive were recruited. Brachial and central blood pressures (BP), cardiac output (CO), peripheral vascular resistance (PVR), aortic stiffness, blood biochemistry and platelet aggregation were assessed. Results: Women with previous PE/IUGR had higher brachial diastolic BP (78 ± 9 vs 71 ± 7 mmHg; p = 0.03), central systolic BP (107 ± 10 vs 99 ± 8 mmHg; p = 0.03), mean arterial pressure (92 ± 10 vs 84 ± 8 mmHg; p = 0.01) and PVR (1499 ± 300 vs 1250 ± 220 dynes.s⁻¹ cm⁻⁵; p = 0.005), than the controls. No differences were observed in either cardiovascular function or blood biochemistry in women with unexplained RM compared with the controls. Women with previous PE/IUGR though not with RM had a stronger family history of cardiovascular disease (CVD) than controls. Conclusions: Women with previous PE and/or IUGR had higher BP and PVR compared with controls, which may predispose them to CVD later in life. However, in the absence of underlying vascular pathology, women with unexplained RM did not have abnormal cardiovascular function. Prepregnancy period provides an opportunity to identify cardiovascular risks in relation to previous obstetric history.

Keywords::

• Prepregnancy
• blood pressure
• peripheral vascular resistance
• arterial stiffness
• pregnancy complications

Acknowledgements

We wish to thank all the women who participated in the study.

Declaration of Interest: The authors report no conflict of interest. The ovulation and pregnancy tests were provided free of cost by Swiss Precision Diagnostics, GmbH (SPD) Bedford. AAM is supported by Cambridge Fetal Care and Flexibility and Sustainability Funding from the National Institute of Health Research (NIHR), UK. TRE is funded by Evelyn Trust. IBW and CMM are both British Heart Foundation Fellows and are supported by the Cambridge Biomedical Research Centre (NIHR) and the Comprehensive Local Research Network (CLRN), UK. CCL/IBW conceived the study design. AAM wrote the study protocol, obtained ethics and performed the study. AAM, CCL, CMM wrote the first draft. IBW, CMM, TRE were involved in the writing and reviewing of the final manuscript.