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Objectives: To assess first trimester serum placental growth factor (PLGF), soluble fms‐like tyrosine kinase‐1 (sFLT‐1), interleukin‐6 (IL‐6), tumour necrosis factor‐α (TNF‐α), endothelin and vascular cell adhesion molecule (VCAM) in women with chronic hypertension (CH) stratified according to blood pressure (BP) control. Design: Case–control. Setting: Tertiary referral centre. Population: 650 women with CH, 142 normotensive controls. Methods: In the first trimester, patients with CH were subdivided into four groups. Group 1 included women without pre‐pregnancy CH presenting with BP ≥140/90 mmHg. Groups 2–4 had pre‐pregnancy CH; in group 2 the BP was <140/90 mmHg without antihypertensive medication, in group 3 the BP was <140/90 mmHg with antihypertensive medication, and in group 4 the BP was ≥140/90 mmHg despite antihypertensive medication. PLGF, sFLT‐1, IL‐6, TNF‐α, endothelin and VCAM were measured at 11+0–13+6 weeks' gestation and converted into multiples of the expected median (MoM) using multivariate regression analysis in the controls. Main outcome measure: Comparisons of MoM values of PLGF, sFLT‐1, endothelin, IL‐6, TNF‐α and VCAM between the entire cohort of women with CH and the control group were made using Student's t‐test or Mann–Whitney U‐test. Comparisons between the four CH groups were made using analysis of variance or Kruskal–Wallis tests. Results: Compared with the control group, women with CH had significantly lower MoM of PLGF, sFLT‐1 and IL‐6 and a significantly higher MoM of endothelin. Between the four groups of women with CH, there were no significant differences in the MoM of sFLT‐1, PLGF, sFLT‐1/PLGF ratio, endothelin, IL‐6 or VCAM, or in the levels of TNF‐ α. Conclusion: In women with CH, differences exist in first trimester angiogenic and inflammatory profiles when compared with normotensive pregnancies. However, these differences do not assist in the stratification of women with CH to identify those with more severe underlying disease and worse pregnancy outcomes. First trimester blood pressure control impacts on serum PLGF, sFLT‐1, endothelin and IL‐6 in women with chronic hypertension. First trimester blood pressure control impacts on serum PLGF, sFLT‐1, endothelin and IL‐6 in women with chronic hypertension. This article includes Author Insights, a video abstract available at: https://vimeo.com/bjog/authorinsights16835 [ABSTRACT FROM AUTHOR]

Objective: To compare maternal haemodynamics in women at low and high risk for preterm pre-eclampsia (PE), and between those at high risk who are randomised to aspirin or placebo.Design: Prospective, longitudinal observational study.Setting: Maternity units in six UK hospitals.Population: Women participating in the Aspirin for Prevention of Preterm Pre-eclampsia (ASPRE) trial. The population comprised three groups of women: low risk for preterm PE (n = 1362), high risk for preterm PE treated with aspirin (n = 208) and high risk for preterm PE on placebo (n = 220).Methods: Women had four visits during pregnancy: 11-14, 19-24, 30-34, and 35-37 weeks' gestation. Blood pressure was measured with a device validated for pregnancy, and PE and maternal haemodynamics were assessed with a bioreactance monitor at each visit. A multilevel linear mixed-effects analysis was performed to examine longitudinal changes of maternal haemodynamic variables, controlling for demographic characteristics, past medical history and medication use.Main Outcome Measures: Longitudinal changes of cardiac output (CO), mean arterial pressure (MAP), and peripheral vascular resistance (PVR).Results: The low-risk group demonstrated the expected changes with an increase in CO and reduction in MAP and PVR, with a quadratic change across gestation. In contrast, the high-risk groups had a declining CO, and higher MAP and PVR during pregnancy. The administration of aspirin did not appear to affect maternal haemodynamics.Conclusions: Women screened as high risk for preterm PE have a pathological cardiac adaptation to pregnancy and the prophylactic use of aspirin (150 mg oral daily from the first trimester) in this group may not alter this haemodynamic profile.Tweetable Abstract: In women at high risk of pre-eclampsia, prophylactic use of aspirin may not alter the impaired maternal cardiac adaptation. [ABSTRACT FROM AUTHOR]

Objective: To assess maternal cardiac function in nulliparous women in the first trimester of pregnancy and evaluate its potential role for predicting pre-eclampsia and small for gestational age (SGA). Design: Prospective, observational, cross-sectional study. Setting: Maternity unit of a teaching hospital. Population: Nulliparous women with singleton pregnancies presenting consecutively for routine antenatal care (n= 534). Methods: Two-dimensional and M-mode echocardiography and uterine artery Dopplers were carried out at 11-14 weeks. Main Outcome Measures: Cardiac output (CO), stroke volume (SV), mean arterial pressure (MAP), total vascular resistance and uterine artery pulsatility index (UAPI) were compared in four outcome groups according to the development of pre-eclampsia and/or SGA. Results: Compared with the normal outcome group (n= 457), in those with pre-eclampsia but not SGA (n = 8), CO and MAP were increased; in the group with pre-eclampsia and SGA (n= 19) MAP, TRP and UAPI were increased and in the group with SGA but no pre-eclampsia (n= 50) total peripheral resistance and UAPI were increased. Independent predictors of pre-eclampsia were MAP, SV and UAPI and of SGA SV and UAPI. Conclusions: Alterations in maternal cardiac function and UAPI are observed in the first trimester of pregnancy in nulliparous women that subsequently develop pre-eclampsia and/or SGA. [ABSTRACT FROM AUTHOR]