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An elevated maternal cardiac output in the first trimester predicts the development of preeclampsia, whereas a decreased output predicts delivery of a small-for-gestational-age infant, new research shows.

As reported in the February issue of Obstetrics & Gynecology, Dr. Kypros H. Nicolaides, from King's College Hospital in London, and colleagues used echocardiography to measure cardiac output in women between 11 and 13 weeks of gestation. Cardiac output was then compared among 83 women who developed preeclampsia, 87 with pregnancy-induced hypertension, 532 with an SGA infant, and 3591 unaffected women.

In women without pregnancy complications, cardiac output rose with gestation and maternal weight and fell with maternal age.

Correlates of increased cardiac output included prior birth, cigarette smoking, use of anti-hypertensive agents or beta-mimetics, and conception after in vitro fertilization. Afro-Caribbean origin, by contrast, was predictive of lower cardiac output.

Relative to the unaffected group, women who developed preeclampsia and pregnancy-induced hypertension had higher cardiac output, while those with SGA infants had lower output.

The researchers calculate that for a ten per cent false-positive rate, cardiac output testing in conjunction with standard risk assessment identified 43.4 per cent of women with preeclampsia, 52.2 per cent with preeclampsia but lacking SGA, 23.3 per cent with pregnancy-induced hypertension, and 23.9 per cent with SGA.

"In pregnancies complicated by preeclampsia and SGA, there are alterations in maternal central hemodynamics that predate the clinical onset of the disorders and are detectable at 11 to 13 weeks of gestation," the investigators conclude.