The relationship between hemodynamics and inflammatory activation in womenat risk for preeclampsia

OBJECTIVE: This study evaluated: 1) whether women with risk factors for pre eclampsia had a hyperdynamic circulation and increased markers of endotheli al and inflammatory activation; and 2) whether hemodynamically directed the rapy was associated with a change in markers. METHODS: A controlled experimental study was performed for two groups: 1) w omen at risk for preeclampsia (high risk); and 2) women at low risk (contro ls). Tumor necrosis factor-alpha (TNF-alpha), TNF-alpha receptors 1 and 2, vascular cell adhesion molecule-1, cellular fibronectin, and cardiac output were measured at or before 24 weeks' gestation and at 6-8 week intervals. High-risk subjects with cardiac output greater than 7.4 L/minute were treat ed with atenolol. Atenolol therapy was not randomized. Therefore, the longi tudinal data were descriptive. Data were analyzed by the t test, Wilcoxon r ank sum test, chi (2) test, multivariable linear regression, and the standa rd two-stage test. RESULTS: There were 46 high-risk subjects and 25 controls. Maternal age, ge stational age, and parity did not differ between the groups. Cardiac output (P <.001) and vascular cell adhesion molecule-1 (P =.02) at baseline were significantly increased in the high-risk group. A total of 42 women in the high-risk group received atenolol for high cardiac output. There was a slow er rise in TNF-<alpha> receptor I in the treated group compared with the co ntrols (P <.001). CONCLUSION: Women with risk factors for preeclampsia had a hyperdynamic cir culation and endothelial activation. Hemodynamically directed therapy in wo men at risk was associated with a slower rise in TNF-<alpha> receptor 1 com pared with low risk women who were not treated, suggesting a relationship b etween hemodynamics and inflammatory activation. (Obstet Gynecol 2001;98:11 09-16. (C) 2001 by the American College of Obstetricians and Gynecologists. ).