Pulse Wave Velocity as a Tool for Cardiometabolic Risk Stratification in Individuals With Hypertensive Disorders of Pregnancy and Increased BMI

Abstract

Objectives

Obesity is one of the most prevalent risk factors for hypertensive disorders of pregnancy (HDP); however, the role of pre-pregnancy cardiometabolic health in the development of these conditions is not well understood. Carotid-femoral pulse wave velocity (PWV) is an established measure of arterial stiffness and cardiovascular health and is validated in pregnancy. Our objective was to examine the obesity-related changes in PWV in pregnant individuals with and without HDP.

Methods

Overall, 87 individuals with singleton pregnancies were recruited and classified into 2 groups: cases (HDP: including pre-existing/chronic hypertension, gestational hypertension, preeclampsia, or intrauterine growth restriction; n = 39) and normotensive controls (no HDP or intrauterine growth restriction; n = 48). Patient data, including BMI, were collected from patient charts. Measurements of PWV were performed weekly until discharge or delivery (gestational age 23⁰–38⁰ weeks) and placental growth factor (PlGF) was measured at routine blood draws.

Results

PWV did not significantly change over gestation for either group. Cases had significantly increased PWV and decreased PlGF compared to normotensive controls. An elevated BMI was associated with higher PWV in both cases and controls. Once grouped based on BMI, PWV was only significantly higher in cases with a BMI ≥25 kg/m² compared to controls, whereas PlGF was less affected by BMI. As PWV increased, PlGF decreased; however, after controlling for BMI, there was no relationship between PWV and PlGF.

Conclusions

PWV measurements in early pregnancy may be useful as an additional independent marker to PlGF for risk-stratifying for HDP, especially in individuals with increased BMI.