• S J S Sep, M P H Schreurs, S C A M Bekkers, A J Kruse, L J Smits, and L L H Peeters.
• Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands. s.sep@mumc.nl
• BJOG. 2011 Aug 1;118(9):1112-9.

ObjectiveTo compare early-pregnancy changes in cardiac diastolic function between formerly pre-eclamptic women with (RECUR) and without (NORECUR) recurrent pre-eclampsia.DesignRetrospective observational cohort study.SettingTertiary referral centre.PopulationPregnant women with a history of early-onset pre-eclampsia (n = 34).MethodsThe peak mitral filling velocity in early diastole (E) and at atrial contraction (A), and the E/A ratio were assessed before and at 12, 16 and 20 weeks of gestation in the next pregnancy. Differences in early-pregnancy alterations between women with (RECUR) and without (NORECUR) recurrent pre-eclampsia were evaluated by use of mixed design analysis of covariance.Main Outcome MeasuresCardiac function and recurrent pre-eclampsia.ResultsIn ten women (29%) pre-eclampsia recurred. By 12 weeks of gestation the E/A ratio had increased in the RECUR group, but not in the NORECUR group (P < 0.01). Moreover, from 16 weeks of gestation onwards, the RECUR group had a lower cardiac output and higher systemic vascular resistance as compared with the NORECUR group (P < 0.05).ConclusionOur results suggest that formerly pre-eclamptic women destined to develop recurrent pre-eclampsia differ from their counterparts who do not develop recurrent pre-eclampsia by impaired first-trimester adaptation of cardiac diastolic function.© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

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