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OC28.06: Pregnancy complicated by type 1 diabetes, type 2 diabetes and gestational diabetes: maternal hemodynamic assessment and subsequent complications

Methods: 192 CH patients were submitted to an echocardiographic examination before pregnancy and at 22-24 weeks’ gestation, assessing left ventricular morphology, cardiac output (CO) and Total Vascular Resistance (TVR). Patients were followed until delivery and were retrospectively divided in: those without complications; those with complications before 34 weeks’ gestation, and those with complications after 34 weeks’ gestation. Results: 141 patients had no complications, 24 patients showed early complications (7 superimposed pre-eclampsia [SPE]; 10 intrauterine growth restriction [FGR]; 6 SPE+FGR; 1 HELLP syndrome), and 27 had late complications (20 SPE; 3 FGR; 4 SPE+FGR). Before pregnancy three different hemodynamic profiles were identified: early complications with low CO and high TVR (4.8 ± 0.8 L and 1669 ± 236 dyne•s•cm-5); late complications with high CO and low TVR (7.2 ± 1.5 L and 1112 ± 243 dyne•s•cm-5); no complications with intermediate values of CO and TVR (6.3 ± 1.3 L and 1332 ± 266 dyne•s•cm-5). Patients without or with late complications during pregnancy showed a reduction of TVR (1332 ± 266 vs. 1153 ± 194 dyne•s•cm-5; 1112 ± 243 vs. 826 ± 140 dyne•s•cm-5, respectively; p < 0.05) and an increase in CO (6.3 ± 1.3 L vs. 7.2 ± 1.2; 7.2 ± 1.5 L vs. 9.6 ± 1.6, respectively; p < 0.05), whereas patients with early complications did not show significant changes in CO and TVR. Conclusions: Chronic hypertensive patients with an ‘‘optimal’’ cardiovascular adaptation before and during pregnancy show a uncomplicated outcome; in case of deviation above or below the ‘‘optimal’’ range of TVR and CO is possible to find the clinical complications of the second and third trimester of pregnancy.