Latent hemodynamic abnormalities in symptom-free women with a history of preeclampsia

OBJECTIVE: Most women with a pregnancy complicated by preeclampsia have eit her hypertension or a disorder with a thrombophilic phenotype or both of th ese. In this study we evaluated whether hemodynamic variables and volume ho meostasis in a subgroup of normotensive women with a history of preeclampsi a with normal clotting function (defined as the symptom-free subgroup) were comparable with those in a healthy parous control group. STUDY DESIGN: In a group of 58 subjects with a history of preeclampsia and a group of 11 healthy parous control subjects we measured the following var iables greater than or equal to 5 months past partum at day 5 +/- 2 of the menstrual cycle: body weight and length, mean arterial pressure, heart rate , cardiac output, plasma volume, glomerular filtration rate, effective rena l plasma flow, and plasma concentrations of volume regulatory hormones, clo tting factors, antiphospholipid antibodies, and homocysteine before and aft er a methionine load. From the measured data we calculated body mass index, body surface area, cardiac index, left ventricular work, total peripheral and renal vascular resistances, effective renal blood flow, and renal filtr ation fraction. RESULTS: Among women with a history of preeclampsia 26 were normotensive wi th thrombophilia (45%), 14 had hypertension (24%), and 18 were normotensive without thrombophilia (31%). These last symptom-free subjects with a histo ry of preeclampsia were more obese than were control subjects. They also ha d higher cardiac output and left ventricular work and a lower plasma volume than the healthy parous control subjects. Thus they resemble the second su bgroup of subjects (subjects with hypertension and a history of preeclampsi a) rather than the control subjects. The hemodynamic and renal functions in the subgroup of subjects with a history of preeclampsia with normotension and thrombophilia were similar to those in healthy parous control subjects. CONCLUSION: On the basis of this study we conclude that hemodynamic paramet ers and volume homeostasis in the symptom-free subgroup of women with a his tory of preeclampsia are different from those in healthy parous control sub jects. Hemodynamic parameters and volume homeostasis in this subgroup resem ble those of women with hypertension and a history of preeclampsia. We ther efore propose the classification of these symptom-free subjects with a hist ory of preeclampsia as having "latent" hypertension.