Corresponding author:
Dr Deesha Patel
Academic Department of Obstetrics and Gynaecology,
Department of Metabolism, Digestion and Reproduction, Imperial College
London, Chelsea & Westminster Hospital,
369 Fulham Road, London SW10 9NH, UK
Tel: +44 20 3315 8000
Fax: +44 20 8846 7796
Email: deesha.patel@doctors.org.uk
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Objective
Obesity is known to be associated with cardiovascular compromise and is
a major risk factor for the development of hypertensive disorders in
pregnancy. The aim of this study was to investigate the effect of
obesity on the maternal cardiovascular system.
Design
This was a prospective, observational, longitudinal study.
Setting
A tertiary centre in London
Population
Pregnant women with booking body mass index (BMI) ≥ 30kg/m2 (n=64) were
compared to pregnant women with normal booking BMI (20-24.9kg/m2)
(n=14).
Methods
Two-dimensional trans-thoracic echocardiography.
Main outcomes
Longitudinal difference in blood pressure, cardiac geometry and cardiac
function between the groups.
Results
In women with obesity, the blood pressure, heart rate and cardiac output
were higher and peripheral vascular resistance was lower
(p<0.01 for all) compared to normal BMI women. Women with
obesity had altered cardiac geometry with higher left ventricular end
diastolic diameter, relative wall thickness and left ventricular mass
(p<0.001 for all comparisons). There was also evidence of
impaired diastolic indices in the obese group with lower E/A ratio, TDI
E’ lateral and medial and higher left atrial volume (p<0.01
for all). Finally, women with obesity had reduced longitudinal function
between the second and third trimester of pregnancy indicating possible
early cardiac dysfunction in this group.
Conclusions
Obesity is associated with maternal hyperdynamic circulation, altered
cardiac geometry and suboptimal diastolic function compared to normal
BMI pregnant women; this may contribute to the increased risk of
complications in obese pregnant women.
Funding
UK charities: Borne and CW+