Am J Perinatol 2015; 32(14): 1318-1323
DOI: 10.1055/s-0035-1563719
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effects of Maternal Position and Habitus on Maternal Cardiovascular Parameters as Measured by Cardiac Magnetic Resonance

David B. Nelson
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Robert D. Stewart
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Susan A. Matulevicius
2   Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
,
Jamie L. Morgan
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Donald D. McIntire
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Mark Drazner
2   Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
,
F. Gary Cunningham
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
› Institutsangaben
Weitere Informationen

Publikationsverlauf

21. Juli 2015

21. Juli 2015

Publikationsdatum:
16. September 2015 (online)

Abstract

Objective To evaluate left ventricular stroke volume (LVSV) and cardiac output (CO) according to maternal position and habitus throughout pregnancy and postpartum using serial cardiac magnetic resonance imaging (c-MRI).

Study Design This was a prospective study of normotensive nulliparous women using 1.5-T c-MRI performed in both left lateral decubitus and supine positions during three epochs in pregnancy and at 12 weeks' postpartum. Women were stratified according to prepregnancy body mass indices (BMIs) as normal or overweight/obese and compared for LVSV and CO using repeated measures, mixed-random, and fixed-effects model.

Results Between October 2012 and December 2014, 14 normal-weight (BMI 22.2 ± 1.3) and 9 overweight/obese (BMI 29.1 ± 2.0) women underwent c-MRI. During early pregnancy, position did not alter LVSV or CO for either cohort. Beginning at 26 to 30 weeks and continuing to 32 to 36 weeks, normal-weight women demonstrated significant positional differences for LVSV and CO (both p < 0.01). In contrast, positional differences did not influence these parameters in overweight/obese women. At 12 weeks' postpartum, all influence of position had dissipated for both cohorts.

Conclusion Maternal position has no effect on LVSV or CO during the first half of pregnancy. In the second half, however, only normal-weight women exhibit significant changes in cardiac parameters when comparing the left lateral decubitus with supine position.

Note

Portions of this manuscript were presented at Society for Maternal-Fetal Medicine 35th Annual Meeting—The Pregnancy Meeting, San Diego, CA, Poster Presentation Session III, February 6, 2015.


 
  • References

  • 1 Linard J. Uber das Minutenvolume des Herzens bei Ruhe und bei Muskelarbeit. Pflugers Arch 1915; 161: 223
  • 2 Ueland K, Metcalfe J. Circulatory changes in pregnancy. Clin Obstet Gynecol 1975; 18 (3) 41-50
  • 3 Clark SL, Cotton DB, Lee W , et al. Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol 1989; 161 (6, Pt 1): 1439-1442
  • 4 Germain P, Roul G, Kastler B, Mossard JM, Bareiss P, Sacrez A. Inter-study variability in left ventricular mass measurement. Comparison between M-mode echography and MRI. Eur Heart J 1992; 13 (8) 1011-1019
  • 5 Bellenger NG, Burgess MI, Ray SG , et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable?. Eur Heart J 2000; 21 (16) 1387-1396
  • 6 Ducas RA, Elliott JE, Melnyk SF , et al. Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study. J Cardiovasc Magn Reson 2014; 16: 1
  • 7 Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular magnetic resonance in patients with myocardial infarction: current and emerging applications. J Am Coll Cardiol 2009; 55 (1) 1-16
  • 8 Waksmonski CA. Cardiac imaging and functional assessment in pregnancy. Semin Perinatol 2014; 38 (5) 240-244
  • 9 Kilner PJ, Geva T, Kaemmerer H, Trindade PT, Schwitter J, Webb GD. Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology. Eur Heart J 2010; 31 (7) 794-805
  • 10 Rossi A, Cornette J, Johnson MR , et al. Quantitative cardiovascular magnetic resonance in pregnant women: cross-sectional analysis of physiological parameters throughout pregnancy and the impact of the supine position. J Cardiovasc Magn Reson 2011; 13: 31
  • 11 Clark SL, Cotton DB, Pivarnik JM , et al. Position change and central hemodynamic profile during normal third-trimester pregnancy and post partum. Am J Obstet Gynecol 1991; 164 (3) 883-887
  • 12 Metcalfe J, McAnulty JH, Ueland K. Cardiovascular physiology. Clin Obstet Gynecol 1981; 24 (3) 693-710
  • 13 van Oppen AC, van der Tweel I, Duvekot JJ, Bruinse HW. Use of cardiac index in pregnancy: is it justified?. Am J Obstet Gynecol 1995; 173 (3, Pt 1): 923-928
  • 14 Desai DK, Moodley J, Naidoo DP. Echocardiographic assessment of cardiovascular hemodynamics in normal pregnancy. Obstet Gynecol 2004; 104 (1) 20-29
  • 15 Drazner MH, Dries DL, Peshock RM , et al. Left ventricular hypertrophy is more prevalent in blacks than whites in the general population: the Dallas Heart Study. Hypertension 2005; 46 (1) 124-129
  • 16 Yancy CW. The role of race in heart failure therapy. Curr Cardiol Rep 2002; 4 (3) 218-225
  • 17 Yancy CW. Heart failure in African Americans: unique etiology and pharmacologic treatment responses. J Natl Med Assoc 2003; 95 (1) 1-9 , quiz 10–12
  • 18 Yancy CW. Does race matter in heart failure?. Am Heart J 2003; 146 (2) 203-206
  • 19 Yancy CW. Heart failure in African Americans. Am J Cardiol 2005; 96 (7B): 3i-12i
  • 20 Gordon A, Raynes-Greenow C, Bond D, Morris J, Rawlinson W, Jeffery H. Sleep position, fetal growth restriction, and late-pregnancy stillbirth: the Sydney stillbirth study. Obstet Gynecol 2015; 125 (2) 347-355
  • 21 Stacey T, Thompson JM, Mitchell EA, Ekeroma AJ, Zuccollo JM, McCowan LM. Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ 2011; 342: d3403