Pre-eclampsia Linked To Distinct Maternal Heart Patterns

Pre-eclampsia can be linked to two distinct, measurable patterns of abnormal maternal cardiovascular function, according to a new scientific impact paper. These patterns can be identified before symptoms of the condition become obvious, and sometimes even before pregnancy begins.

Over the past two decades, technological advances have made it possible to measure key aspects of a pregnant woman's heart and circulatory system using simple, non-invasive tests. These tests can establish whether a mother's cardiovascular system has unusual features that may place her at higher risk of complications. They can also monitor whether her body is adapting to pregnancy in the expected way.

Profiling can measure cardiac output, which is the volume of blood pumped by the heart per minute, and vascular resistance, which is the physical resistance to blood flow within the vessels. Repeat testing can identify individual measurements, or patterns of measurements, that are cause for concern.

Two Cardiovascular Phenotypes

Research has revealed two distinct patterns of abnormal cardiovascular measurements in women with pre-eclampsia. The paper states that some pregnant women who have a lower volume of blood being pumped out of their hearts per minute, known as low cardiac output, are more at risk of being affected by pre-eclampsia earlier in pregnancy. They are also more likely to have a baby with a low birth weight.

In contrast, women who develop pre-eclampsia later in pregnancy typically have more circulating blood volume. Their babies are often of normal or larger size.

The paper argues that this evidence strongly suggests pre-eclampsia is not a singular disease process when viewed from the standpoint of a woman's cardiovascular function. It aims to summarize the concept of different, treatable phenotypes of the condition.

The Potential for Personalized Care

Recognizing these distinct features provides an opportunity to individualize treatment plans. A personalized plan could include tailored monitoring and the use of drugs most likely to be effective in restoring balance to that individual's circulatory system.

"The drugs that lower blood pressure work in different ways and the opportunity exists to target therapy to the underlying problem," the paper notes. Early recognition, before symptoms start, allows for timely reviews and earlier treatment. This can lower the incidence of serious complications for the mother, such as seizures or stroke.

There is clear evidence that managing pre-eclampsia can be improved by more detailed cardiovascular evaluation and tailored monitoring, according to the paper.

Barriers to Clinical Implementation

Despite this potential, the paper states that at the time of writing, many of the non-invasive tests able to identify women at risk are typically only used in research settings. Routine clinical use of available tests is not yet standard.

The establishment of clear care pathways and defined parameters for risk assessment based on maternal heart and circulation test results would allow for more targeted treatment. The paper argues this would assist in preventing avoidable harm.

The guidance is intended for healthcare professionals and emphasizes that gynaecological and obstetric services must be inclusive and sensitive to the needs of all individuals, including those whose gender identity does not align with the sex they were assigned at birth.