Non-pregnant circulatory volume status predicts subsequent pregnancy outcome in normotensive thrombophilic formerly preeclamptic women

Background: Preeclampsia seems to be superimposed upon a preexisting hemody namic, hemostatic, autoimmune or metabolic disorder, We tested the hypothes is that in normotensive thrombophilic formerly preeclamptic subjects, the n on-pregnant circulatory volume status predicts the development of subsequen t hypertensive pregnancy and/or fetal growth restriction. Methods: In 250 non-diabetic formerly preeclamptic women and 15 normal paro us controls, we measured and calculated the following variables at least 5 months postpartum at day 5 (+/-2) of the menstrual cycle: mean arterial pre ssure, body mass index, plasma volume and the clotting function. In the sub sequent pregnancy we determined, birth weight, birth-weight centile and the incidence of preterm birth, fetal growth restriction, pregnancy-induced hy pertension, preeclampsia and HELLP-syndrome. We only included in the final analysis normotensive subjects with a thrombophilic phenotype at the time o f the pre-pregnant screening, who had a subsequent singleton pregnancy, ong oing beyond 16 weeks gestation within 1 year after pre-pregnant evaluation. As a consequence, 23 formerly preeclamptic women and 12 controls were elig ible for final analysis. The thrombophilic formerly preeclamptic participan ts received aspirin in combination with low-molecular-weight heparin throug hout pregnancy. If thrombophilia was diagnosed on the basis of hyperhomocys teinemia, the treatment consisted of aspirin, pyridoxine and folic acid, in stead. Results: Among 250 formerly preeclamptic 131/250 (52%) had a normotensive t hrombophilic phenotype. Only 23 (18%) of these 131 participants had an ongo ing pregnancy within 1 year. They were allocated to subgroup THROMB. None o f the controls had hypertension or thrombophilia. In contrast, 12/15 (80%) controls had an ongoing pregnancy within a year. The observations in the TH ROMB subgroup were compared with those in the control group. None of the ba seline demographic and bloodpressure variables differed between THROMB and controls. With respect to pregnancy outcome, the incidence of the following pregnancy complications were observed in THROMB subjects: preterm birth: 9 %, pregnancy-induced hypertension: 44%, preeclampsia: 13%, HELLP-syndrome: 13%, and fetal growth restriction: 30%. A low non-pregnant plasma volume wa s found to predispose for hypertensive complications in a subsequent pregna ncy. Conclusion: Pre-pregnant plasma volume in normotensive thrombophilic former ly preeclamptic women have predictive value with respect to hypertensive co mplications in the subsequent pregnancy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.