Publications by authors named "Eva G Mulder"

6 Publications

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Inappropriate left ventricular mass after HELLP syndrome inappropriate LVM after HELLP syndrome.

Pregnancy Hypertens 2021 Nov 12;27:16-22. Epub 2021 Nov 12.

Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardiology, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), the Netherlands.

Objectives: Excessive left ventricular mass (LVM) results in inefficient LV work with energy waste leading to a negative prognostic effect. We aimed at investigating the presence of inappropriate LVM and calculating the myocardial mechano-energetic efficiency index (MEEi) in former pre-eclamptic (PE) women (with or without HELLP syndrome) compared to women who experienced HELLP syndrome without PE.

Study Design: In this cross-sectional study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent echocardiography as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity.

Main Outcome Measures: LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was considered as the ratio between stroke work and "double product" (to approximate energy consumption), indexed to LVM.

Results: LV hypertrophy was present in 8-14% and concentric remodeling in 31-42% of women, without intergroup difference. LVM was inappropriate in one-third of normotensive former HELLP and in about one-half of PE with or without HELLP, with no difference among groups. Accordingly, without nominal difference, MEEi showed a tendency towards lower values in former pre-eclamptic individuals.

Conclusions: Women with a history of HELLP syndrome, independently from the presence/absence of PE, showed inappropriate LVM in the first 4 years after delivery, which may partially explain the elevated CV risk in these women compared to the general female population.
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http://dx.doi.org/10.1016/j.preghy.2021.11.003DOI Listing
November 2021

Maternal myocardial dysfunction after hemolysis, elevated liver enzymes, and low platelets syndrome: a speckle-tracking study.

J Hypertens 2021 10;39(10):1956-1963

Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands.

Objectives: Pregnancy complicated by pre-eclampsia (PE) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is associated with an increased risk of cardiovascular (CV) diseases later in life. Subclinical cardiac alterations precede eminent CV diseases. Speckle-tracking echocardiography (STE) is an effective method to assess subclinical myocardial dysfunction. We performed a myocardial speckle tracking study to investigate the prevalence of subclinical myocardial dysfunction in former PE patients (with and without HELLP syndrome) compared to normotensive women affected by HELLP syndrome.

Methods: In this cross-sectional retrospective study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent conventional and STE as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity.

Results: Women with a history of PE with HELLP syndrome were characterized by a higher prevalence of altered left ventricular circumferential and global longitudinal two-dimensional (2D) strain (74 and 20%, respectively), altered right ventricular longitudinal 2D strain (37%), and left atrial (LA) 2D strain (57%). Moreover, a higher proportion of alterations of biventricular and LA strains was also present in former PE without HELLP as well as in the normotensive HELLP group.

Conclusions: In the first years after a pregnancy complicated by HELLP syndrome, irrespective of whether there was concomitant PE, a higher rate of abnormal STE myocardial function is observed. Therefore, these women may benefit from CV risk management.
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http://dx.doi.org/10.1097/HJH.0000000000002901DOI Listing
October 2021

Preventing Recurrent Preeclampsia by Tailored Treatment of Nonphysiologic Hemodynamic Adjustments to Pregnancy.

Hypertension 2021 06 5;77(6):2045-2053. Epub 2021 Apr 5.

Department of Obstetrics and Gynecology (E.G.M., E.C., V.A.L.v.B., V.M.M.M.S., R.J.A., M.E.A.S.), Maastricht University Medical Centre, the Netherlands.

[Figure: see text].
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16502DOI Listing
June 2021

Maternal myocardial dysfunction after normotensive fetal growth restriction compared with hypertensive pregnancies: a speckle-tracking study.

J Hypertens 2020 10;38(10):1955-1963

Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands.

Objective: Pregnancy complicated by preeclampsia and fetal growth restriction (FGR) relates to increased risk of cardiovascular disease later in life, but to different extents. Subclinical cardiac alterations precede eminent cardiovascular disease. Speckle-tracking echocardiography is an elegant method to assess subclinical myocardial dysfunction. We performed a myocardial speckle tracking study to evaluate the prevalence of subclinical myocardial dysfunction in former preeclampsia patients (with and without FGR) compared with normotensive women with FGR.

Methods: For this cross-sectional study, we retrospectively selected women with a history of normotensive FGR (n = 17), preeclampsia with FGR (n = 26) and preeclampsia without FGR (n = 134) who underwent conventional echocardiography as part of the clinical cardiovascular work-up after complicated pregnancies between 6 months and 4 years postpartum in Maastricht, The Netherlands. We excluded women with chronic hypertension, hypercholesterolemia and obesity.

Results: Women with normotensive FGR showed subclinical left ventricular (LV) impairment in systodiastolic function with concentric remodeling, slight alteration in right ventricular systolic function and left atrial strain, similarly to the preeclampsia group independently from the fetal growth. LV hypertrophy was only present in about 10% of cases who experienced preeclampsia (independently from the fetal growth) but not in those with normotensive FGR.

Conclusion: Similar to women with a history preeclampsia, women with a history of normotensive pregnancy but with FGR have abnormal myocardial function, shown with speckle-tracking echocardiography. Therefore, both preeclampsia and normotensive FGR should be viewed upon as risk indicator for subclinical myocardial impairment that may benefit from cardiovascular risk management.
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http://dx.doi.org/10.1097/HJH.0000000000002496DOI Listing
October 2020

Recurrence rates of preeclampsia over the past 20 years in women assessed for non-pregnant cardiovascular risk factors.

Pregnancy Hypertens 2018 Oct 22;14:150-155. Epub 2018 Sep 22.

Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, the Netherlands. Electronic address:

Objective: Several efforts to reduce recurrent preeclampsia have been implemented in clinical practice in the past decades. We assessed whether recurrence rates of preeclampsia and related offspring complications decreased in the past 20 years in women who received tailored preventive advices.

Study Design: In this observational cohort study, we included 752 women who had their first pregnancy complicated by preeclampsia between 1996 and 2012, and who participated in a non-pregnant risk factor assessment. A questionnaire was sent to women to follow-up on their next pregnancy outcome.

Main Outcome Measures: Prevalence of preeclampsia and related offspring complications in the subsequent pregnancy.

Results: 467 (62%) women responded to the questionnaire of which two-thirds had a subsequent ongoing pregnancy. Recurrent preeclampsia occurred in 29% of women who delivered between 1997 and 2004, in 20% of women who delivered between 2005 and 2009, and in 24% of women who delivered between 2010 and 2016 (overall p-value = 0.319). Combined maternal complications did not change over time (OR 0.98 per year, 95% CI 0.93-1.04, p-value = 0.503). Offspring complications in the subsequent pregnancy decreased over time with an OR of 0.92 (95% CI 0.86-0.98, p = 0.009) per year.

Conclusion: Recurrence rates of preeclampsia did not decrease over the past 20 years in women who have been extensively assessed on cardiovascular risk factors. In the same period, foetal and neonatal outcomes improved substantially. Efforts to extend and improve strategies to reduce recurrence risk of preeclampsia still seem to be necessary.
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http://dx.doi.org/10.1016/j.preghy.2018.09.006DOI Listing
October 2018

Homeostatic model assessment of beta cell function predicting abnormal oral glucose tolerance testing in pregnancy: a systematic review and meta-analysis.

Gynecol Endocrinol 2017 Dec 28;33(12):911-917. Epub 2017 Aug 28.

a Department of Obstetrics and Gynecology , Maastricht University Medical Center , Maastricht , The Netherlands.

Background: Gestational diabetes mellitus (GDM) complicates 1-14% of pregnancies and relates to increased risk of adverse obstetric outcomes. Currently GDM is diagnosed using an oral glucose tolerance test (OGTT), which is burdensome and time intensive.

Objective: To compare current literature on whether the homeostatic model assessment beta cell function (HOMA-β) is an accurate predictor of an abnormal OGTT in pregnant women.

Methods: Pubmed, Cochrane and Embase were searched. Included studies evaluated pregnant women at risk for GDM using the homeostatic model assessment of beta cell function (HOMA-β) for the assessment of beta cell function and the OGTT. Studies with animals, non-pregnant women, women with type 2 diabetes and post-partum diabetes were excluded. The QUADAS-2 criteria were used to assess the methodological quality of studies.

Results: A total of 12 studies were included, reporting on 7292 women. Seven studies showed a difference in beta cell function between women with impaired glucose tolerance compared to healthy pregnant women. HOMA-β is significantly lower in impaired glucose tolerance (p < 0.001).

Conclusions: Although HOMA-β is lower in women with abnormal OGTT in pregnancy, given the high degree of heterogeneity of studies, we do not propagate HOMA-β as a sole diagnostic tool replacing OGTT to diagnose GDM.
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http://dx.doi.org/10.1080/09513590.2017.1369516DOI Listing
December 2017
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