Our studies showed that women at risk for PE have distinct cardiac functional changes prior to the clinical development of PE, but these are largely explained by differences in maternal characteristics. Similarly, women with GDM have a distinct risk factor profile which increases both the risk for GDM development but also contributes to an adverse cardiac functional profile. Our data would, therefore, suggest that routine maternal cardiovascular assessment in mid-gestation would not offer incremental information for the prediction of PE or GDM.Regarding the specific evaluation of the relationship between maternal ophthalmic artery Doppler and cardiovascular function we can conclude that the second to first PSV ratio in the ophthalmic artery in pregnancy can provide useful information about peripheral vascular resistance. Considering that PSV ratio in women that develop PE was associated with left ventricular mass we suggest that increased peripheral vascular resistance and changes in vascular tone are the primary changes in women with PE and these drive the cardiac alterations. As cardiac afterload increases, the structure of the heart is modified by increasing left ventricular thickness to maintain cardiac output; however, with prolongedexposure functional cardiac alterations occur with decrease in diastolic and systolic indices as demonstrated in our previous screening study at 35-36 weeks¿ gestation. Further studies are needed to demonstrate whether monitoring of the PSV ratio can also provide information about cardiac adaptations during pregnancy

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