The cardio-ankle vascular index as a predictor of adverse pregnancy outcomes

Objective: To assess the association between maternal hemodynamic parameters; cardio-ankle vascular index (CAVI), representing arterial stiffness; mean arterial pressure (MAP), uterine artery pulsatility index (Ut-PI), and adverse pregnancy outcomes including preeclampsia (PE), fetal growth restriction (FGR), and gestational diabetes mellitus (GDM).

Methods: A prospective cohort study was conducted on low-risk pregnancies. All were serially measured for the mean CAVI, MAP, and Ut-PI for four times at gestational age (GA) 11-14, 18-22, 28-32, and after 36 weeks. Also, the women were followed up for pregnancy outcomes, focusing on PE, FGR, and GDM.

Results: Of 335 recruited cases meeting the inclusion criteria, 16 cases developed PE, 24 cases had FGR, and 83 cases had GDM. Compared to the non-PE group, women developing PE had a significant increase in CAVI at 18-22, 28-32, and after 36 weeks (P-value = 0.021, 0.003, and <0.001, respectively), a significant increase in MAP at all of the four periods (P-value < 0.001, for all periods), and a significant increase in Ut-PI during GA 18-22 weeks (P-value = 0.021). In pregnancies with FGR, there was a significant increase of CAVI at GA 18-22, 28-32 and after 36 weeks (P-value = 0.012, 0.015, and 0.004, respectively), an increase in Ut-PI in all gestational periods (P-value < 0.05) but no changes of MAP throughout pregnancy. In GDM, the three parameters were not significantly different from those in the non-GDM group in all of the four periods. CAVI could predict PE and FGR with AUC of 0.655-0.835 and 0.673-0.760, respectively. CAVI added predictive values when combined with MAP or Ut-PI.

Conclusion: Increased CAVI, like MAP and Ut-PI, can be used as a predictor of PE and FGR but not GDM. Also, it has an added predictive value when combined with MAP or Ut-PI.