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424: Increased peripheral vascular resistance and arterial stiffness one year after preeclampsia

      Objective

      Preeclampsia is associated with excess risk of future cardiovascular disease (CVD). One hypothesized mechanism is that persistent vascular dysfunction after delivery may link preeclampsia with later CVD. Our aim was to compare vascular resistance and arterial stiffness one-year postpartum following preeclampsia and uncomplicated pregnancy.

      Study Design

      This is a case-control study of women with preeclampsia and uncomplicated pregnancies who were prospectively recruited and underwent a follow up visit one year postpartum. Women were recruited from labor and delivery with either uncomplicated pregnancies or with preeclampsia. Outcomes were adjudicated by a panel of study physicians. At one-year postpartum, we used EndoPAT peripheral artery tonometry to measure microvascular vasodilatory response to postischemic hyperemia and arterial stiffness [augmentation index (AI) and augmentation index normalized to heart rate, with lower values reflecting more arterial elasticity]. Bioreactance cardiography was performed using the NICOM device to assess hemodynamics adjusted for body surface area, including cardiac index (CI) and total peripheral resistance index (TPRI). Statistical analysis was performed using univariate analysis.

      Results

      Fourteen women with prior preeclampsia were compared to twenty-four controls at a mean time point of 12.8 ± 1.4 months postpartum. Demographic characteristics and blood pressure postpartum were similar between groups. Prior preeclampsia was associated with higher AI compared to uncomplicated pregnancies (median -7.6% vs. - 2.1%, p=0.04) indicating increased arterial stiffness. There was no difference in cardiac index between groups (median 3.6 vs. 3.7 L/min/m2, p=0.9), however TPRI was significantly higher in women with prior preeclampsia (median 1781 vs. 1987 dynes-sec/cm5/m2, p=0.04).

      Conclusion

      In this prospective cohort followed one year postpartum we show significant differences in vascular function associated with prior preeclampsia with higher vascular resistance and increased arterial stiffness using non-invasive vascular assessments. These measures have been extensively validated in a non-obstetric population and are associated with CVD risk. These findings may provide insight into mechanisms linking preeclampsia to future CVD and the identified post-preeclampsia physiology may be a target for risk-reducing interventions.
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