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Assessment of arterial function in pregnancy: what about peripheral arterial tonometry?

We read with great interest the recommendations of the International Working Group on Maternal Hemodynamics on techniques and devices for assessment of arterial function in pregnancy1. There is growing interest in the involvement of maternal cardiovascular (CV) system in both complicated and uncomplicated pregnancies. Arterial dysfunction is considered a hallmark of subclinical CV failure in different settings, representing an early predictor of adverse outcomes2–4. Several pilot studies hypothesized the usefulness of arterial stiffness and endothelial function assessment, combined with biochemical or biophysical markers, in predicting pregnancy complications5,6. We wholeheartedly endorse the ‘recommendations for future research’ presented in the Expert Consensus, and agree that these techniques are able to identify subclinical CV dysfunction which may be addressed by targeted therapy. Given the importance of further research in this area, these recommendations serve as a ‘handbook’ for those who wish to focus their work towards this field. In this context, we are disappointed by the omission of peripheral arterial tonometry (PAT) from the recommended methods for assessment of endothelial function. Moreover, one of the references7 included in the paper has been linked erroneously to flow-mediated dilation (FMD) even though it focuses on PAT technique. Here, we aim to raise readers’ awareness of the usefulness of PAT for endothelial function assessment in pregnancy. PAT can be obtained using the EndoPAT-2000 device (Itamar Medical Ltd., Caesarea, Israel), which has been