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

2003; Wiley; Volume: 110; Issue: 11 Linguagem: Inglês

10.1111/j.1471-0528.2003.02536.x

1471-0528

Robert Aardenburg, Marc Spaanderman, Timo Ekhart, Hugo W. van Eijndhoven, Olivier W.H. van der Heijden, Louis L.H. Peeters,

Pregnancy-related medical research

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.Prospective observational study.Tertiary obstetric centre.Formerly pre-eclamptic women and controls.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.Recurrent hypertensive disease of pregnancy.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.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.