A prospective study of implantation, maternal cardiovascular function and pregnancy outcome

Events at embryonic implantation play a key role in the establishment of successful pregnancy. Not only is delayed implantation associated with an increased incidence of early pregnancy loss, but may also be associated with impaired trophoblastic invasion and uteroplacental insufficiency. Furthermore, uteroplacental vascular mal-adaptation may also be affected by pre-existing maternal cardiovascular function and associated with maternal cardiovascular maladaptation during pregnancy. There is limited understanding of events surrounding human implantation because of the difficulties in conducting prospective studies from prior to pregnancy and an inability to study events at the trophoblast-decidual interface in vivo. The primary objective of this study was to test the feasibility of being able to conduct and complete a prospective study from prior to pregnancy to the postpartum period combining measures of ovulation, implantation, ultrasound measurements of fetal size and cardiovascular changes during pregnancy. The secondary objective was to investigate ovulation and implantation timing using digital home ovulation and pregnancy test kits along with cardiovascular changes in relation to various pregnancy complications and fetal growth to determine the power for a future prospective study. This was a prospective cohort feasibility study of 143 women planning to conceive. Pre-pregnancy cardiovascular function was investigated in all women. We observed ovulation, implantation timing in 101 pregnancies and investigated the relationship between implantation timing, embryonic and fetal growth, birthweight and length of gestation in the 69 viable pregnancies. Longitudinal cardiovascular changes in viable pregnancies were examined in relation both to previous obstetric history and index pregnancy outcome. Normal pregnancy was associated with profound cardiovascular changes, beginning from 6 weeks of gestation. Delayed implantation was associated with early pregnancy loss and a smaller first trimester fetal size. The incremental rise in cardiac output from before pregnancy to its peak in the second trimester was associated with birthweight. It is feasible to conduct and complete a prospective study from prior to pregnancy to the postpartum period. Larger prospective studies of this nature will enable an understanding of the events surrounding implantation including the ‘cause and effect’ relationship of cardiovascular function with pregnancy complications such as preeclampsia and fetal growth restriction.

Name dc:type.qualificationname

other

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

University of East Anglia

Year dc:date.issued

2012

Author dc:creator

• Mahendru, Amita

Language dc:language

en