3.7 ARTERIAL STIFFNESS FOR THE EARLY PREDICTION OF PRE-ECLAMPSIA COMPARED WITH CLINICAL CHARACTERISTICS, UTERINE ARTERY DOPPLER INDICES, AND ANGIOGENIC BIOMARKERS

Abstract

Objective: To develop a model for the 1st trimester prediction of pre-eclampsia. Methods: In this prospective longitudinal study, women with high-risk singleton pregnancies were recruited and arterial stiffness was measured using applanation tonometry (SphygmoCor, AtCor) and compared between women who developed PE and those who had a normotensive pregnancy. Arterial stiffness and hemodynamics were assessed, in the 1st trimester, every 4 weeks thereafter, and at 6 weeks postpartum. Angiogenic biomarker concentrations (Quantikine, R&D Systems) were measured at each trimester and at 6 weeks postpartum, and a bilateral uterine artery Doppler (UAD) was performed in the 2nd trimester. Results: Of the 155 women recruited, 13 developed pre-eclampsia. Analyses adjusted for both maternal age and body mass index showed women who developed pre-eclampsia had significantly increased wave reflection and carotid-femoral pulse wave velocity (cfPWV) from the 1st trimester, throughout pregnancy, and at 6 weeks post-partum with a cfPWV:carotid-radial PWV mistmatch seen in the 1st and 3rd trimester (all p-values<0.05). Arterial stiffness (AUC: 0.80) was a better predictive tool than angiogenic biomarkers (AUC: 0.60; p=0.04) or UAD (AUC: 0.53; p<0.001) and improved detection of pre-eclampsia when combined with all other predictions (AS sensitivity: 79.8% vs other combinations’ sensitivity: 69.2%). Conclusions: Arterial stiffness and wave reflection is higher in the 1st trimester, throughout pregnancy, and does not resolve 6 weeks after pregnancy in women who develop pre-eclampsia. It also had superior preeclampsia predictive value over angiogenic biomarkers and UAD alone and improved detection rates when combined with all predictors including clinical characteristics.