Pregnancy is a dynamic process associated with changes in vascular and rheological resistance. Maternal maladaptation to these changes is the leading cause of pregnancy complications such as preeclampsia.
OBJECTIVE:
This study aimed to assess the hemorheological alterations in pregnancies with a high risk for preeclampsia in the first trimester.
METHODS:
Ninety-two pregnant women were allocated into the high preeclampsia risk group (37 cases) and control groups (55 cases). Plasma and whole blood viscosity and red blood cell morphodynamic properties, including deformability and aggregation were assessed by Brookfield viscometer and laser-assisted optical rotational cell analyzer (LORRCA) at 11–14 gestational weeks.
RESULTS:
Whole blood viscosity was significantly higher in the high-risk group at all shear rates. Plasma viscosity and hematologic factors showed no differences between the groups. Hematocrit levels positively correlated with high blood viscosity only in the high-risk group. There were no significant changes in the other deformability and aggregation parameters.
CONCLUSIONS:
Changes in the whole blood viscosity of pregnant women with high preeclampsia risk refer to impaired microcirculation beginning from the early weeks of gestation. We suggest that the whole blood viscosity is consistent with the preeclampsia risk assessment in the first trimester, and its measurement might be promising for identifying high-preeclampsia-risk pregnancies.
OhlmannP, JungF, MrowietzC, AltT, AltS, SchmidtW. Peripheral microcirculation during pregnancy and in women with pregnancy induced hypertension. Clinical Hemorheology and Microcirculation. 2001;24(3):183–91.
OhlmannP, JungF, CavallaroM, KiesewetterH, SchmidtW. Adaptation of peripheral microcirculation in the course of pregnancy. Zentralblatt Fur Gynakologie. 1994;116(3):143–6.
5.
Jeyabalan AEpidemiology of preeclampsia: Impact of obesity. Nutr Rev. 2013;71 Suppl 1(0 1):18–25.
6.
SibaiBM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol. 2003;102(1):181–92.
SayL, ChouD, GemmillAet al. Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.
9.
BrownMA, MageeLA, KennyLCet al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72(1):24–43.
10.
PoweCE, LevineRJ, KarumanchiSAPreeclampsia, a disease of the maternal endothelium: The role of antiangiogenic factors and implications for later cardiovascular disease. Circulation. 2011;123(24):2856–69.
11.
Sánchez-ArangurenLC, PradaCE, Riaño-MedinaCE, LopezM. Endothelial dysfunction and preeclampsia: Roleof oxidative stress. Front Physiol. 2014;5:372.
12.
LiuS, LiW, ZhangJ, QiL, DongY, FuL, LiY Clinical value of flow-mediated dilatation of brachial artery in hypertensive disorders complicating pregnancy. Clinical Hemorheology and Microcirculation. (Preprint), 2022; 1-10.
13.
BaskurtOK, MeiselmanHJ. Blood rheology and hemodynamics. Semin Thromb Hemost. 2003;29(5):435–50.
14.
KoenigW, SundM, FilipiakB, DöringA, LöwelH, ErnstE. Plasma viscosity and the risk of coronary heart disease: Results from the MONICA-Augsburg Cohort Study, 1984 to 1992. Arteriosclerosis, Thrombosis, and Vascular Biology. 1998;18.5;768–72.
Martínez-MoralesS, Bonillo-PeralesA, Muñoz-HoyosA, et al. The influence of maternal erythrocyte deformability on fetal growth, gestational age and birthweight. J Perinat Med. 1999;27(3):166–72.
17.
MetryG, AdhikarlaR, SchneditzD, RoncoC, LevinNW. Effect of changes in the intravascular volume during hemodialysis on blood viscoelasticity. Indian J Nephrol. 2011;21(2):95–100.
18.
HeilmannL, RathW, PollowK. Hemorheological changes in women with severe preeclampsia. Clin Hemorheol Microcirc. 2004;31(1):49–58.
19.
SolimanAA, CsorbaR, YilmazA, TsikoarasP, von TempelhoffGFRheologic results and their correlation to hemostatic changes in patients with moderate and severe preeclampsia: An observational cross-sectional study. Clin Hemorheol Microcirc. 2015;59(1):1–15.
20.
CsiszarB, GalosG, FunkeSet al. Peripartum investigation of red blood cell properties in women diagnosed with early-onset preeclampsia. Cells. 2021;10(10):2714.
21.
AkolekarR, SyngelakiA, PoonL, WrightD, NicolaidesKH. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn Ther. 2013;33(1):8–15.
22.
WrightD, WrightA, NicolaidesKH. The competing risk approach for prediction of preeclampsia. Am J Obstet Gynecol. 2020;223(1):12–23.e7.
23.
RolnikDL, WrightD, PoonLC, O’GormanN, SyngelakiA, de Paco Matallana C, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. New England Journal of Medicine. 2017;377(7):613–22.
24.
CaritisS, SibaiB, HauthJ, LindheimerMD, KlebanoffM, ThomE, et al. Low-dose aspirin to prevent preeclampsia in women at high risk. New England Journal of Medicine. 1998;338(11):701–5.
25.
CombsCA, MontgomeryDM. Society for Maternal-Fetal Medicine Special Statement: Checklists for preeclampsia risk-factor screening to guide recommendations for prophylactic low-dose aspirin. Am J Obstet Gynecol. 2020;223(3).
26.
PoonLC, ShennanA, HyettJA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention [published correction appears in Int J Gynaecol Obstet. 2019;146(3):390-1].. Int J Gynaecol Obstet.. 2019;145 Suppl 1(Suppl 1):1–33.
27.
National Collaborating Centre forWomen>’s and Children>’s Health (UK). Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. London: RCOG Press; 2010.
HardemanMR, DobbeJG, InceC. The Laser-assisted Optical Rotational Cell Analyzer (LORCA) as red blood cell aggregometer. Clin Hemorheol Microcirc. 2001;25(1):1–11.
30.
AlbrechtED, PepeGJ. Regulation of uterine spiral artery remodeling: A review. Reprod Sci. 2020;27(10):1932–42.
31.
MandelD, LittnerY, MimouniFB, DollbergS. Nucleated red blood cells in polycythemic infants. Am J Obstet Gynecol. 2003;188(1):193–5.
32.
CarbillonL, UzanM, UzanS. Pregnancy, vascular tone, and maternal hemodynamics: A crucial adaptation. Obstet Gynecol Surv. 2000;55(9):574–581.
33.
MokaS, KoutsiarisAG, GarasA, MessinisI, TachmitziSV, GiannoukasA, TsironiEEBlood flow velocity comparison in the eye capillaries and postcapillary venules between normal pregnant and non-pregnant women. Microvascular Research. 2020;127:103926.
34.
GeorgeRB, MunroA, AbdoI, McKeenDM, LehmannCAn observational assessment of the sublingual microcirculation of pregnant and non-pregnant women. International Journal of Obstetric Anesthesia. 2014;23(1):23–8.
35.
HeilmannL, SiekmannUHemodynamic and hemorheological profiles in women with proteinuric hypertension of pregnancy and in pregnant controls. Arch Gynecol Obstet. 1989;246(3):159–68.
36.
SchaufB, LangU, StuteP, SchneiderS, DietzK, AydenizB, WallwienerD. Reduced red blood cell deformability, an indicator for high fetal or maternal risk, is found in preeclampsia and IUGR. Hypertens Pregnancy. 2002;21(2):147–60.
37.
BeggTB, HearnsJBComponents in blood viscosity. The relative contribution of haematocrit, plasma fibrinogen and other proteins. Clinical Science. 1966;31(1):87–93.
38.
KussN, BauknechtE, FelbingerC, GehmJ, GehmL, PöschlJ, RuefPDetermination of whole blood and plasma viscosity in term neonates by flow curve analysis with the LS300 viscometer1. Clin Hemorheol Microcirc. 2015;63(1):3–14.
39.
Hernández HernándezJD, VillaseñorOR, Del Rio AlvaradoJ, LucachRO, ZárateA, SaucedoR, Hernández-ValenciaMMorphological changes of red blood cells in peripheral blood smear of patients withpregnancy-related hypertensive disorders. Arch Med Res. 2015;46(6):479–83.
40.
GamzuR, BarshteinG, TsipisF, LessingJB, BerlinerAS, KupfermincMJ, EldorA, YedgarS. Pregnancy-induced hypertension is associated with elevation of aggregability of red blood cells. Clin Hemorheol Microcirc27(3-4):2002)163–9.
41.
GreseleP, GuercioliniR, NenciGG. Erythrocyte deformability changes in normal pregnancy and pre-eclampsia. Br J Haematol. 1982;52(2):340–2.
42.
TranquilliAL, GarzettiGG, De Tommaso G, BoemiM, LucinoE, FumelliP, RomaniniC. Nifedipine treatment in preeclampsia reverts the increased erythrocyte aggregation to normal. Am J Obstet Gynecol. 1992;167(4 Pt 1):942–5.
43.
OzanneP, LinderkampO, MillerFC, MeiselmanHJErythrocyte aggregation during normal pregnancy. Am J Obstet Gynecol. 1983;147(5):576–83.
44.
PeppleDJ, HardemanMR, MullingsAM, ReidHLErythrocyte deformability and erythrocyte aggregation in preeclampsia. Clin Hemorheol Microcirc. 2001;24(1):43–8.
45.
LangGD, LoweGD, WalkerJJ, ForbesCD, PrenticeCR, CalderAABlood rheology in pre-eclampsia and intrauterine growth retardation: Effects of blood pressure reduction with labetalol. Br J Obstet Gynaecol. 1984;91(5):438–43.
46.
InglisTC, StuartJ, GeorgeAJ, DaviesAJ. Haemostatic and rheological changes in normal pregnancy and pre-eclampsia. Br J Haematol. 1982;50(3):461–5.
