The effect of parity on longitudinal maternal hemodynamics
Publication in refereed journal

香港中文大學研究人員
替代計量分析
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其它資訊
摘要Background Parous women have a lower risk for pregnancy complications, such as preeclampsia or delivery of small-for-gestational-age neonates. However, parous women are a heterogeneous group of patients because they contain a low-risk cohort with previously uncomplicated pregnancies and a high-risk cohort with previous pregnancies complicated by preeclampsia and/or small for gestational age. Previous studies examining the effect of parity on maternal hemodynamics, including cardiac output and peripheral vascular resistance, did not distinguish between parous women with and without a history of preeclampsia or small for gestational age and reported contradictory results. Objective The objective of the study was to compare maternal hemodynamics in nulliparous women and in parous women with and without previous preeclampsia and/or small for gestational age. Study Design This was a prospective, longitudinal study of maternal hemodynamics, assessed by a bioreactance method, measured at 11+0 to 13+6, 19+0 to 24+0, 30+0 to 34+0, and 35+0 to 37+0 weeks’ gestation in 3 groups of women. Group 1 was composed of parous women without a history of preeclampsia and/or small for gestational age (n = 632), group 2 was composed of nulliparous women (n = 829), and group 3 was composed of parous women with a history of preeclampsia and/or small for gestational age (n = 113). A multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal characteristics, medical history, and development of preeclampsia or small for gestational age in the current pregnancy. Results In groups 1 and 2, cardiac output increased with gestational age to a peak at 32 weeks and peripheral vascular resistance showed a reversed pattern with its nadir at 32 weeks; in group 1, compared with group 2, there was better cardiac adaptation, reflected in higher cardiac output and lower peripheral vascular resistance. In group 3 there was a hyperdynamic profile of higher cardiac output and lower peripheral vascular resistance at the first trimester followed by an earlier sharp decline of cardiac output and increase of peripheral vascular resistance from midgestation. The incidence of preeclampsia and small for gestational age was highest in group 3 and lowest in group 1. Conclusion There are parity-specific differences in maternal cardiac adaptation in pregnancy.
出版社接受日期27.03.2019
著者Ling Hua Zen, Guy Gavin P., Bisquera Alessandra, Poon Liona C., Nicolaides Kypros H., Kametas Nikos A.
期刊名稱American Journal of Obstetrics and Gynecology
出版年份2019
月份9
卷號221
期次3
出版社Elsevier
頁次249.e1 - 249.e14
國際標準期刊號0002-9378
電子國際標準期刊號1097-6868
語言英式英語
關鍵詞bioreactance, cardiac output, fetal growth restriction, hemodynamics, nulliparous, parity, parous, peripheral vascular resistance, placental insufficiency, preeclampsia, pregnancy, small for gestational age

上次更新時間 2021-26-02 於 02:19