Screening for pre-eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non-obese patients

Objective To test if maternal hemodynamics and bioimpedance, assessed at the time of combined screening for PE, are able to identify in the first trimester of gestation normotensive non-obese patients at risk for pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR).Methods One hundred and fifty healthy nulliparous non-obese women (body mass index < 30 kg/m(2)) in the first trimester of pregnancy underwent assessment by UltraSonic Cardiac Output Monitor (USCOM) to detect hemodynamic parameters, bioimpedance analysis to characterize body composition, and combined screening for PE (assessment of maternal history, biophysical and maternal biochemical markers). Patients were followed until term, noting the appearance of PE and/or IUGR.Results One hundred and thirty-eight patients had an uneventful pregnancy (controls), while 12 (8%) developed complications (cases). USCOM showed, in cases compared with controls, lower cardiac output (5.6 +/- 0.3 vs 6.7 +/- 1.1 L/min, P < 0.001), lower inotropy index (1.54 +/- 0.38 vs 1.91 +/- 0.32 W/m(2), P < 0.001) and higher total vascular resistance (1279.8 +/- 166.4 vs 1061.4 +/- 179.5 dynes x s/cm(5), P < 0.001). Bioimpedance analysis showed, in cases compared with controls, lower total body water (53.7 +/- 3.3% vs 57.2 +/- 5.6%, P=0.037). Combined screening was positive for PE in 8% of the controls and in 50% of the cases (P < 0.001). After identification of cut-off values for USCOM and bioimpedance parameters, forward multivariate logistic regression analysis identified as independent predictors of complications in pregnancy the inotropy index (derived by USCOM), fat mass (derived from bioimpedance analysis) and combined screening.Conclusions Combined screening for PE and assessment of bioimpedance and maternal hemodynamics can be used to identify early markers of impaired cardiovascular adaptation and body composition that may lead to complications in the third trimester of pregnancy. Copyright (C) 2016 ISUOG. Published by John Wiley & Sons Ltd