Photoplethysmography in assessment of skin microcirculation in pregnant women with gestational arterial hypertension

Introduction. One of the urgent problems of modern obstetrics is gestational arterial hypertension (GAH), which entails a whole range of complications for both mother and fetus. In this regard, it is necessary to search for economically accessible, informative and safe methods for early diagnosis of uteroplacental blood flow disorders in pregnant women.

The aim of the study was to investigate the features of peripheral and uteroplacental blood flow in pregnant women with GAH, to assess the state of the vascular wall of pregnant women using photoplethysmography and to determine its association with uteroplacental blood flow disorders. 

Materials and methods. A total of 78 patients with 22 to 40 weeks of pregnancy, divided into two groups, were clinically examined: the first group (n=42) were pregnant women with GAH, the second group the control group (n=36) consisted of patients with physiological course of gestation. The study included assessment of the objective clinical status of the pregnant woman, recording and contour analysis of photoplethysmograms, ultrasound examination of the uteroplacental and fetoplacental blood flow, and statistical processing of the results.

Results. When comparing the anthropometric characteristics of the studied groups, an increase in BMI was found in the group of pregnant women with GAG (p<0.05). Contour analysis of photoplethysmography (PPG) data showed an increase in the augmentation index in pregnant women with GAG by 73.47 % (p=0.054), an increase in central arterial pressure by 3.6 % (p<0.05). Changes in peripheral hemodynamics in pregnant women with hypertensive disorder were associated with impaired fetoplacental blood flow (rxy = 0.52-0.86, p < 0.05), which was accompanied by lower fetal biometry parameters (p<0.05).

Conclusion. Hemodynamic disturbances in the mother-placenta-fetus system correlate with changes in the parameters of peripheral circulation, which allows us to consider the additional use of the photoplethysmography method as promising in terms of early diagnostics and prevention of perinatal complications in mother and fetus.

1. Smith AN, Wang X, Thomas DG, Tatum RE, Booz GW, Cunningham MW. The Role of Mitochondrial Dysfunction in Preeclampsia: Causative Factor or Collateral Damage? Am J Hypertens. 2021;34(5):442-452. Doi: 10.1093/ajh/hpab003.

2. Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res. 2019;124(7):1094-1112. Doi: 10.1161/CIRCRESAHA.118.313276. Erratum in: Circ Res. 2020;126(1):e8. Doi: 10.1161/RES.0000000000000315.

3. Espeche W, Minetto J, Leiva Sisnieguez CE, Cerri G, Carrera Ramos P, Olano D, Salazar MR. Time in therapeutic range and risk of preeclampsia in chronic hypertensive pregnant women. Hypertens Res. 2024;47(10):2895-2901. Doi: 10.1038/s41440-024-01830-4.

4. Gureev VV. Endothelial dysfunction is a central link in the pathogenesis of gestosis. Curr Issues Med. 2012;17(4(123)):5-12. (In Russ.).

5. Possomato-Vieira JS, Khalil RA. Mechanisms of Endo thelial Dysfunction in Hypertensive Pregnancy and Preeclampsia. Adv Pharmacol. 2016;77:361-431. Doi: 10.1016/bs.apha.2016.04.008.

6. Vlasova TI, Petrishchev NN, Vlasov TD. Endothelial dysfunction as the typical pathological state. Regional blood circulation and microcirculation. 2022;21(2):4-15. (In Russ.). Doi: 10.24884/1682-6655-2022-21-2-4-15.

7. Valensise H, Vasapollo B, Novelli GP, Pasqualetti P, Galante A, Arduini D. Maternal total vascular resistance and concentric geometry: a key to identify uncomplicated gestational hypertension. BJOG. 2006;113:1044-1052. Doi: 10.1111/j.1471-0528.2006.01013.

8. Masini G, Foo LF, Tay J, Wilkinson IB, Valensise H, Gyselaers W, Lees CC. Preeclampsia has two phenotypes which require different treatment strategies. Am J Obstet Gynecol. 2022;226(2S):S1006-S1018. Doi: 10.1016/j.ajog.2020.10.052.

9. Novelli GP, Vasapollo B, Valensise H. Hemodynamic Prediction and Stratification of Hypertensive Disorders of Pregnancy: A Dream That Is Coming True? J Am Heart Assoc. 2018;7(14):e010084. Doi: 10.1161/JAHA.118.010084.

10. Johnson A, Vaithilingan S, Ragunathan L. Association of obesity and overweight with the risk of preeclampsia in pregnant women: an observational cohort study. Ir J Med Sci. 2024. Doi: 10.1007/s11845-024-03787-2.

11. Kireev SS, Tokarev AR. Central and peripheral hemodynamics in obesity (Literature review of the problem and own research). Bull New Med Technol. 2015;9(2):31. (In Russ.). Doi: 10.12737/11432.

12. Schiavone MJ, Pérez MP, Aquieri A, Nosetto D, Pronotti MV, Mazzei M, Kudrle C, Avaca H. The Role of Obesity in the Development of Preeclampsia. Curr Hypertens Rep. 2024;26(6):247-258. Doi: 10.1007/s11906-024-01299-z.

13. Rogers BN, Stephens JM, Sones JL. Linking inflammatory adipose tissue to placental abnormalities in obese preeclamptic pregnancies. Physiol Genomics. 2022;54(8):319- 324. Doi: 10.1152/physiolgenomics.00041.2022.

14. Kuzmin VN. Fetoplacental insufficiency: a problem of modern obstetrics. Lechaschi Vrach. 2011;(3):50-54. (In Russ.).

15. Sun X, Su F, Chen X, Peng Q, Luo X, Hao X. Doppler ultrasound and photoplethysmographic assessment for identifying pregnancy-induced hypertension. Exp Ther Med. 2020;19(3):1955-1960. Doi: 10.3892/etm.2019.8405.

16. Han N, Luo X, Su F. A quantitative investigation of hemodynamic adaptation to pregnancy using uterine artery Doppler ultrasonography and finger photoplethysmography. Hypertens Pregnancy. 2014;33(4):498-507. Doi: 10.3109/10641955.2014.946615.

17. Dorogova IV, Usanov VD, Bartos LF, Panina ES, Bocharnikov DY. Features of parameters of peripheral, central blood pressure and indicators of vessels rigidity in pregnant women with hypertensive disorders. Regional blood circulation and microcirculation. 2016;15(2):51- 59. (In Russ.). Doi: 10.24884/1682-6655-2016-15-2-51-59.