Sequential profile of endothelial functions and arterial stiffness in preeclampsia during the course of pregnancy

Objective: To evaluate the temporal profile of arterial functions during the course of pregnancy and also to determine the predictive accuracy of vascular function indices in development of preeclampsia (PE). Study design: Longitudinal study, two hundred and eight women participated in the study and vascular functions were assessed at 11-13, 20-22 and 30-32 weeks of gestation. Main outcome measures: Flow mediated dilatation (FMD), augmentation index (AIx), pulse wave velocity (PWV). Results: Out of 208 women, 13 women developed PE while 70 remained healthy pregnant (HP). In HP women, normalized FMD decreased gradually from 11 to 13 weeks to 30-32 weeks of gestation (p < 0.05). While in PE, Normalized FMD decreased from 11 to 13 to 20-22 weeks of gestation (p < 0.05) and was significantly lower in PE than HP group at 20-22 weeks of gestation (p < 0.05). AIx showed a mid trimester drop in HP group (p < 0.05) while demonstrated a rising trend in PE. Both AIx and PWV were significantly higher in PE than HP group during the course of pregnancy (p < 0.05). AIx demonstrated good sensitivity and specificity at both 11-13 and 20-22 weeks of gestation. Carotid femoral PWV showed an area under curve (AUC) of 78.18% and 69.75% at 11-13 and 20-22 weeks of gestation respectively. Carotid radial PWV showed good accuracy at 20-22 weeks (AUC-77.58%) of gestation. Conclusions: Compromised arterial functions precede the onset of PE. AIx and carotid femoral PWV constitute potential predictive marker in early pregnancy for later development of PE.