Low plasma volume following pregnancy complicated by pre-eclampsia predisposes for hypertensive disease in a next pregnancy.

Autor: Aardenburg R; Department of Obstetrics and Gynaecology, University Maastricht, The Netherlands., Spaanderman ME, Ekhart TH, van Eijndhoven HW, van der Heijden OW, Peeters LL
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2003 Nov; Vol. 110 (11), pp. 1001-6.
Abstrakt: Objective: A large number of women with a history of pre-eclampsia/HELLP have a low plasma volume at least six months postpartum. The objective of this study was to determine whether a low plasma volume in formerly pre-eclamptic women and HELLP patients is associated with an increased risk for recurrent hypertensive complications in a next pregnancy.
Design: Prospective observational study.
Setting: Tertiary obstetric centre.
Sample: Formerly pre-eclamptic women and controls.
Methods: In 316 women with a history of pre-eclampsia and/or HELLP, we measured, plasma volume along with haemodynamic, metabolic and haemostatic variables at least six months postpartum. A group of 22 healthy parous controls was used as a reference. After standardising plasma volume for body mass index, women were subdivided into normotensive and normal plasma volume (n = 199), normotensive and low plasma volume (n = 76) and hypertensive (n = 41) subgroups, which were compared for demography, clinical parameters and course of a next pregnancy.
Main Outcome Measures: Recurrent hypertensive disease of pregnancy.
Results: Relative to the normal plasma volume subgroup, normotensive women in the low plasma volume subgroup have a higher body mass index, a lower total vascular compliance and a shorter estimated systemic circulation time. They have a higher HOMA index and higher fasting triglyceride levels. In normotensive and hypertensive former patients alike, low plasma volume is associated with a higher recurrence of hypertensive complications in a next pregnancy compared with normotensive women with normal plasma volume.
Conclusion: Low plasma volume in normotensive women with a history of pre-eclampsia and/or HELLP is associated with overweight, reduced vascular compliance and insulin resistance and a predisposition for recurrent pre-eclampsia and HELLP syndrome in a next pregnancy.
Databáze: MEDLINE
Externí odkaz: