Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2022; 12(01): e69-e75
DOI: 10.1055/s-0041-1742270
Original Article

Hemodynamic Assessment of Pregnant People with and without Obesity by Noninvasive Bioreactance: A Pilot Study

Ernesto A. Figueiro-Filho
1   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
5   Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
Na T. S. Robinson
1   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
2   Department of Obstetrics and Gynecology, Queen Elizabeth Hospital, Barbados
,
Jose Carvalho
3   Department of Anaesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
,
Johannes Keunen
1   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
,
Monique Robinson
4   Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
,
Cynthia Maxwell
1   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective This study aimed to identify cardiovascular differences between pregnant people with and without obesity for trimester-specific changes in hemodynamic parameters using noninvasive cardiac output monitoring (NICOM).

Study Design This study is a pilot prospective comparative cohort between pregnant people with and without obesity. Hemodynamic assessment was performed with NICOM (12–14, 21–23, and 34–36 weeks) during pregnancy.

Results In first trimester, pregnant people with obesity had higher blood pressure, stroke volume (SV), total peripheral resistance index (TPRI), and cardiac output (CO). Pregnant people with obesity continued to have higher SV and cardiac index (second and third trimesters). During the first trimester, body mass index (BMI) positively correlated with SV, TPRI, and CO. Fat mass showed a strong correlation with TPRI. BMI positively correlated with CO during the second trimester and fat mass was positively associated with CO. During the third trimester, TPR negatively correlated with BMI and fat mass.

Conclusion Fat mass gain in the period between the first and second trimesters in addition to the hemodynamic changes due to obesity and pregnancy contribute to some degree of left ventricular diastolic dysfunction which was manifested by lower SVs. Future work should investigate the possible causative role of obesity in the cardiovascular changes identified in people with obesity.

Keywords

pregnancy - noninvasive cardiac output monitoring - obesity - hemodynamic - pilot study

Financial Support

There was no financial support to this research.




Publication History

Received: 10 June 2020

Accepted: 08 October 2021

Article published online:
04 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 WHO. Obesity and overweight. Accessed December 21, 2021 at: http://www.who.int/mediacentre/factsheets/fs311/en/
    PubMedGoogle Scholar
  • 2 Danias PG, Tritos NA, Stuber M, Kissinger KV, Salton CJ, Manning WJ. Cardiac structure and function in the obese: a cardiovascular magnetic resonance imaging study. J Cardiovasc Magn Reson 2003; 5 (03) 431-438
    CrossrefPubMedGoogle Scholar
  • 3 de Simone G, Devereux RB, Daniels SR. et al. Stroke volume and cardiac output in normotensive children and adults. Assessment of relations with body size and impact of overweight. Circulation 1997; 95 (07) 1837-1843
    CrossrefPubMedGoogle Scholar
  • 4 Poirier P, Giles TD, Bray GA. et al; American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113 (06) 898-918
    CrossrefPubMedGoogle Scholar
  • 5 Robinson MR, Scheuermann-Freestone M, Leeson P. et al. Uncomplicated obesity is associated with abnormal aortic function assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2008; 10: 10
    CrossrefPubMedGoogle Scholar
  • 6 Rider OJ, Petersen SE, Francis JM. et al. Ventricular hypertrophy and cavity dilatation in relation to body mass index in women with uncomplicated obesity. Heart 2011; 97 (03) 203-208
    CrossrefPubMedGoogle Scholar
  • 7 Kenchaiah S, Evans JC, Levy D. et al. Obesity and the risk of heart failure. N Engl J Med 2002; 347 (05) 305-313
    CrossrefPubMedGoogle Scholar
  • 8 He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 2001; 161 (07) 996-1002
    CrossrefPubMedGoogle Scholar
  • 9 Heslehurst N, Simpson H, Ells LJ. et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008; 9 (06) 635-683
    CrossrefPubMedGoogle Scholar
  • 10 American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol 2013; 121 (01) 213-217
    CrossrefPubMedGoogle Scholar
  • 11 Schrauwers C, Dekker G. Maternal and perinatal outcome in obese pregnant patients. J Matern Fetal Neonatal Med 2009; 22 (03) 218-226
    CrossrefPubMedGoogle Scholar
  • 12 O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003; 14 (03) 368-374
    CrossrefPubMedGoogle Scholar
  • 13 Sebire NJ, Jolly M, Harris JP. et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25 (08) 1175-1182
    CrossrefPubMedGoogle Scholar
  • 14 Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation 2009; 119 (01) 147-152
    CrossrefPubMedGoogle Scholar
  • 15 Chung JH, Melsop KA, Gilbert WM. et al. Increasing pre-pregnancy body mass index is predictive of a progressive escalation in adverse pregnancy outcomes. J Matern Fetal Neonatal Med 2012; 25 (09) 1635-1639
    CrossrefPubMedGoogle Scholar
  • 16 Weiss JL, Malone FD, Emig D. et al; FASTER Research Consortium. Obesity, obstetric complications and cesarean delivery rate–a population-based screening study. Am J Obstet Gynecol 2004; 190 (04) 1091-1097
    CrossrefPubMedGoogle Scholar
  • 17 Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ. Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 2005; 112 (04) 403-408
    CrossrefPubMedGoogle Scholar
  • 18 Jolly MC, Sebire NJ, Harris JP, Regan L, Robinson S. Risk factors for macrosomia and its clinical consequences: a study of 350,311 pregnancies. Eur J Obstet Gynecol Reprod Biol 2003; 111 (01) 9-14
    CrossrefPubMedGoogle Scholar
  • 19 Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301 (06) 636-650
    CrossrefPubMedGoogle Scholar
  • 20 Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103 (02) 219-224
    CrossrefPubMedGoogle Scholar
  • 21 Reynolds RM, Allan KM, Raja EA. et al. Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years. BMJ 2013; 347: f4539
    CrossrefPubMedGoogle Scholar
  • 22 Keren H, Burkhoff D, Squara P. Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance. Am J Physiol Heart Circ Physiol 2007; 293 (01) H583-H589
    CrossrefPubMedGoogle Scholar
  • 23 Squara P, Rotcajg D, Denjean D, Estagnasie P, Brusset A. Comparison of monitoring performance of Bioreactance vs. pulse contour during lung recruitment maneuvers. Crit Care 2009; 13 (04) R125
    CrossrefPubMedGoogle Scholar
  • 24 Raval NY, Squara P, Cleman M, Yalamanchili K, Winklmaier M, Burkhoff D. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. J Clin Monit Comput 2008; 22 (02) 113-119
    CrossrefPubMedGoogle Scholar
  • 25 Monteith C, McSweeney L, Breatnach CR. et al. Non-invasive cardiac output monitoring (NICOM) can predict the evolution of uteroplacental disease-Results of the prospective HANDLE study. Eur J Obstet Gynecol Reprod Biol 2017; 216: 116-124
    CrossrefPubMedGoogle Scholar
  • 26 Doherty A, El-Khuffash A, Monteith C. et al. Comparison of bioreactance and echocardiographic non-invasive cardiac output monitoring and myocardial function assessment in primagravida women. Br J Anaesth 2017; 118 (04) 527-532
    CrossrefPubMedGoogle Scholar
  • 27 Doherty A, Ohashi Y, Downey K, Carvalho JC. Non-invasive monitoring based on bioreactance reveals significant hemodynamic instability during elective cesarean delivery under spinal anesthesia [in multiple languages]. Rev Bras Anestesiol 2011; 61 (03) 320-325
    CrossrefPubMedGoogle Scholar
  • 28 Ohashi Y, Ibrahim H, Furtado L, Kingdom J, Carvalho JC. Non-invasive hemodynamic assessment of non-pregnant, healthy pregnant and preeclamptic women using bioreactance [corrected]. Rev Bras Anestesiol 2010; 60 (06) 603-613, 335–340 DOI: 10.1016/S0034-7094(10)70075-1.
    CrossrefPubMedGoogle Scholar
  • 29 Schutte R, Huisman HW, Schutte AE, Malan NT. Leptin is favourably associated with vascular function in obese Caucasians, but not in obese Africans. J Hum Hypertens 2005; 19 (12) 933-939
    CrossrefPubMedGoogle Scholar
  • 30 Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev 2015; 16 (08) 621-638
    CrossrefPubMedGoogle Scholar
  • 31 McMurray JJV, Adamopoulos S, Anker SD. et al; ESC Committee for Practice Guidelines. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33 (14) 1787-1847
    CrossrefPubMedGoogle Scholar
  • 32 Highman TJ, Friedman JE, Huston LP, Wong WW, Catalano PM. Longitudinal changes in maternal serum leptin concentrations, body composition, and resting metabolic rate in pregnancy. Am J Obstet Gynecol 1998; 178 (05) 1010-1015
    CrossrefPubMedGoogle Scholar
  • 33 Lea RG, Howe D, Hannah LT, Bonneau O, Hunter L, Hoggard N. Placental leptin in normal, diabetic and fetal growth-retarded pregnancies. Mol Hum Reprod 2000; 6 (08) 763-769
    CrossrefPubMedGoogle Scholar
  • 34 Mise H, Sagawa N, Matsumoto T. et al. Augmented placental production of leptin in preeclampsia: possible involvement of placental hypoxia. J Clin Endocrinol Metab 1998; 83 (09) 3225-3229
    PubMedGoogle Scholar
  • 35 Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 2006; 368 (9542): 1164-1170
    CrossrefPubMedGoogle Scholar
  • 36 Mochhoury L, Razine R, Kasouati J, Kabiri M, Barkat A. Body mass index, gestational weight gain, and obstetric complications in Moroccan population. J Pregnancy 2013; 2013: 379461
    CrossrefPubMedGoogle Scholar
  • 37 Johnson J, Clifton RG, Roberts JM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network*. Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines. Obstet Gynecol 2013; 121 (05) 969-975
    CrossrefPubMedGoogle Scholar
  • 38 Bouloumie A, Marumo T, Lafontan M, Busse R. Leptin induces oxidative stress in human endothelial cells. FASEB J 1999; 13 (10) 1231-1238
    CrossrefPubMedGoogle Scholar
  • 39 Oda A, Taniguchi T, Yokoyama M. Leptin stimulates rat aortic smooth muscle cell proliferation and migration. Kobe J Med Sci 2001; 47 (03) 141-150
    PubMedGoogle Scholar
  • 40 Parhami F, Tintut Y, Ballard A, Fogelman AM, Demer LL. Leptin enhances the calcification of vascular cells: artery wall as a target of leptin. Circ Res 2001; 88 (09) 954-960
    CrossrefPubMedGoogle Scholar
  • 41 Sweeney G. Cardiovascular effects of leptin. Nat Rev Cardiol 2010; 7 (01) 22-29
    CrossrefPubMedGoogle Scholar
  • 42 Poetsch MS, Strano A, Guan K. Role of leptin in cardiovascular diseases. Front Endocrinol (Lausanne) 2020; 11: 354
    CrossrefPubMedGoogle Scholar