Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy
Background Hypertensive disorders complicating pregnancy are a major cause of maternal death. Our objective was to evaluate maternal clinical, hemodynamic, and placental prognostic indicators in a consolidated manner to identify women who develop hypertension in pregnancy. Methods and Results Twenty...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-07-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009595 |
| _version_ | 1818774992164225024 |
|---|---|
| author | Kelsey McLaughlin Jianhong Zhang Stephen J. Lye John D. Parker John C. Kingdom |
| author_facet | Kelsey McLaughlin Jianhong Zhang Stephen J. Lye John D. Parker John C. Kingdom |
| author_sort | Kelsey McLaughlin |
| collection | DOAJ |
| description | Background Hypertensive disorders complicating pregnancy are a major cause of maternal death. Our objective was to evaluate maternal clinical, hemodynamic, and placental prognostic indicators in a consolidated manner to identify women who develop hypertension in pregnancy. Methods and Results Twenty‐six normotensive pregnant women from a specialized Placenta Clinic at increased risk of developing de novo hypertension and 20 normotensive healthy pregnant controls were recruited at 22 to 26 weeks' gestation. Fourteen maternal clinical, hemodynamic, and placental characteristics were assessed in the second trimester and aggregated. Principal component analysis of this combined data set determined that 3 dimensions accounted for 56% of the cohort variability. The first dimension accounted for 31% of the cohort variability, with significant contributions from total peripheral resistance, endoglin, and cardiac output. The second dimension was predominantly influenced by body mass index and mean arterial pressure, while uric acid and myeloperoxidase mainly contributed to the third dimension. Unsupervised clustering identified 3 groups within this combined data set. Total peripheral resistance was the most significant distinguishing parameter between these groups (P<0.0001), followed by placental growth factor, endoglin, and cardiac output (P<0.0001). Using these 4 parameters, a receiver operating curve was constructed with an area under the curve of 0.975 (95% confidence interval 0.93–1) for the prediction of developing hypertension in pregnancy. Conclusions Consolidated assessment of prognostic indicators in the second trimester of pregnancy may be useful to characterize and distinguish pathways by which women may develop hypertension in pregnancy. This approach could contribute to the development of pathway‐specific preventative and antihypertensive treatment strategies. |
| first_indexed | 2024-12-18T10:49:57Z |
| format | Article |
| id | doaj.art-92aeccaa19e74c1f8088154769440f7a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T10:49:57Z |
| publishDate | 2018-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-92aeccaa19e74c1f8088154769440f7a2022-12-21T21:10:29ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-07-0171410.1161/JAHA.118.009595Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in PregnancyKelsey McLaughlin0Jianhong Zhang1Stephen J. Lye2John D. Parker3John C. Kingdom4Division of Cardiology Department of Medicine Sinai Health System University of Toronto CanadaThe Centre for Women's and Infant's Health at the Lunenfeld‐Tanenbaum Research Institute Sinai Health System Toronto CanadaThe Centre for Women's and Infant's Health at the Lunenfeld‐Tanenbaum Research Institute Sinai Health System Toronto CanadaDivision of Cardiology Department of Medicine Sinai Health System University of Toronto CanadaThe Centre for Women's and Infant's Health at the Lunenfeld‐Tanenbaum Research Institute Sinai Health System Toronto CanadaBackground Hypertensive disorders complicating pregnancy are a major cause of maternal death. Our objective was to evaluate maternal clinical, hemodynamic, and placental prognostic indicators in a consolidated manner to identify women who develop hypertension in pregnancy. Methods and Results Twenty‐six normotensive pregnant women from a specialized Placenta Clinic at increased risk of developing de novo hypertension and 20 normotensive healthy pregnant controls were recruited at 22 to 26 weeks' gestation. Fourteen maternal clinical, hemodynamic, and placental characteristics were assessed in the second trimester and aggregated. Principal component analysis of this combined data set determined that 3 dimensions accounted for 56% of the cohort variability. The first dimension accounted for 31% of the cohort variability, with significant contributions from total peripheral resistance, endoglin, and cardiac output. The second dimension was predominantly influenced by body mass index and mean arterial pressure, while uric acid and myeloperoxidase mainly contributed to the third dimension. Unsupervised clustering identified 3 groups within this combined data set. Total peripheral resistance was the most significant distinguishing parameter between these groups (P<0.0001), followed by placental growth factor, endoglin, and cardiac output (P<0.0001). Using these 4 parameters, a receiver operating curve was constructed with an area under the curve of 0.975 (95% confidence interval 0.93–1) for the prediction of developing hypertension in pregnancy. Conclusions Consolidated assessment of prognostic indicators in the second trimester of pregnancy may be useful to characterize and distinguish pathways by which women may develop hypertension in pregnancy. This approach could contribute to the development of pathway‐specific preventative and antihypertensive treatment strategies.https://www.ahajournals.org/doi/10.1161/JAHA.118.009595hemodynamicshypertensionpreeclampsia/pregnancypregnancy |
| spellingShingle | Kelsey McLaughlin Jianhong Zhang Stephen J. Lye John D. Parker John C. Kingdom Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease hemodynamics hypertension preeclampsia/pregnancy pregnancy |
| title | Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy |
| title_full | Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy |
| title_fullStr | Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy |
| title_full_unstemmed | Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy |
| title_short | Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy |
| title_sort | phenotypes of pregnant women who subsequently develop hypertension in pregnancy |
| topic | hemodynamics hypertension preeclampsia/pregnancy pregnancy |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009595 |
| work_keys_str_mv | AT kelseymclaughlin phenotypesofpregnantwomenwhosubsequentlydevelophypertensioninpregnancy AT jianhongzhang phenotypesofpregnantwomenwhosubsequentlydevelophypertensioninpregnancy AT stephenjlye phenotypesofpregnantwomenwhosubsequentlydevelophypertensioninpregnancy AT johndparker phenotypesofpregnantwomenwhosubsequentlydevelophypertensioninpregnancy AT johnckingdom phenotypesofpregnantwomenwhosubsequentlydevelophypertensioninpregnancy |