MATERNAL WEIGHT, HEMODYNAMICS, AND PREECLAMPSIA

Objectives: To evaluate the relationship between the obesity, elevated cardiac output, and the development of preeclampsia. Methods: Materna l weight, mean arterial pressure, and cardiac output were analyzed fro m 9 preeclamptic, 81 gestationally hypertensive, and 89 normotensive p regnant women at 23 weeks gestation, 34 weeks gestation, and 6-8 weeks postpartum. Data were gathered prospectively and longitudinally as pa rt of a previously described investigation. Cardiac output was measure d by Doppler technique. Data were analyzed by multiple logistic regres sion. The data for cardiac output, weight, and mean arterial pressure were first modeled controlling for the effect of the parameter most st rongly associated with preeclampsia. The data were modeled a second an d third time controlling for the other two parameters. Results: Elevat ed cardiac output, mean arterial pressure, and maternal weight at 23 w eeks and postpartum were each associated with the development of preec lampsia. After controlling for the effects of cardiac output, neither maternal weight nor mean arterial pressure were independently associat ed with the development of preeclampsia. After controlling for materna l weight, elevated cardiac output remained independently associated wi th the development of preeclampsia. Conclusions: Increased maternal we ight and elevated cardiac output are each associated with the developm ent of preeclampsia. While elevated cardiac output has an effect indep endent of maternal weight, we were unable to demonstrate that maternal weight has an independent effect. Given the association between hyper insulinemia, obesity, hypertension, and increased cardiac output in no npregnant patients, a potential association between hyperinsulinemia, increased cardiac output, and the development of preeclampsia deserves further investigation.