Cardiovascular Dysfunction in Children Exposed to Preeclampsia During Fetal Life

Abstract

Background: Keeping in view the developmental origin of health and disease hypothesis, the aim of this study was to assess differences in cardiac and vascular structure and function in children exposed to preeclampsia in utero compared with those of normotensive mothers. The hypothesis under investigation was that children exposed to preeclampsia would have altered cardiac and vascular structure and function compared with the unexposed group.Methods: This was a retrospective cohort study that included children 2 to 10 years of age born to mothers with and without exposure to preeclampsia in utero (n = 80 in each group). Myocardial morphology and function using echocardiography and carotid intima-media thickness and pulse-wave velocity were determined. Multivariate linear regression was used to compare preeclampsia-exposed and nonexposed groups. Subgroup analysis to assess differences between early-and late-onset preeclampsia was also performed.Results: Forty-one percent of mothers (n = 33) had early-onset preeclampsia. Children in the exposed group had a significantly higher prevalence of stage 1 systolic and diastolic hypertension (22% [n = 18] and 35% [n = 18], respectively) compared with the unexposed group (9% [n = 7] and 19% [n = 15], respectively; P = .01). Children in the exposed group also had higher pulse-wave velocity compared with those in the unexposed group (0.42 6 0.1 vs 0.39 6 0.1, P = .03). Subgroup analysis revealed that changes in blood pressure and pulse-wave velocity were determined primarily by early-onset preeclampsia. There was no significant difference in cardiac morphology or systolic and diastolic function between the exposed and unexposed groups. Conclusion:In utero exposure to preeclampsia has an effect on vascular function in children aged 2 to 10 years, related primarily to early-onset disease. Routine blood pressure screening should be recommended for such children.

Preeclampsia and Cardiovascular Risk for Offspring

“…However, the study performed by Hoodboy et al did not find any differences between groups of children exposed and unexposed to PE, assessing over 20 parameters including cardiac morphometry, systolic function, diastolic function, and timing assessment [ 50 ]. No significant associations were observed between groups and cardiac parameters, both in function and structure, including basal septal hypertrophy, basal septal longitudinal strain, LV mass, and LV mass Z score.…”

“…It can be stated that a poorly perfused placenta could lead to oxidative stress within fetal tissues and in the placenta itself. Moreover, the developing heart of the affected child has to deal with increased impedance because of poorly constructed placental microcirculation [ 50 ]. The other issue is the development of the heart itself.…”

Association between hypertensive disorders during pregnancy and elevated blood pressure in offspring: A systematic review and meta‐analysis

“…exposure to PE and GH in utero is associated with higher BP in offspring. [15][16][17]19,20,[27][28][29][30] Offspring from PAH pregnancies had higher BP compared to those from normotensive pregnancies. 40 PE offspring also had higher BP than normotensive offspring.…”

Integrated Metabolomic and Lipidomic Analysis in the Placenta of Preeclampsia

“…The incidence of preeclampsia is 2-8% (ACOG Practice Bulletin No.222, 2020) and causes about 70,000 maternal and 500,000 fetal deaths globally every year (Rana et al, 2019). Furthermore, the effects of preeclampsia on substantial cardiovascular disease and cerebrovascular disease of women and fetuses are life-long (Bergman et al, 2020;Hoodbhoy et al, 2021). Though some researchers have provided important insights into the pathogenesis of preeclampsia and its related complications over the last decade (Karumanchi and Granger, 2016), the mechanisms leading to preeclampsia are only partially known.…”