Impact of pre-eclampsia on the cardiovascular health of the offspring: a cohort study protocol

Abstract

IntroductionPre-eclampsia is a common disorder associated with serious maternal and fetal complications. It is associated with abnormal placentation, which significantly reduces flow, resulting in a relative hypoxic state. These pathophysiological changes lead to subtle macrovascular and cardiac structural and functional changes in the fetus. This can predispose the child with maternal history of pre-eclampsia to risk of premature cardiovascular disease.Methods and analysisThe children will be identified from a cohort of women with pre-eclampsia. The study will be conducted at The Aga Khan University Hospital, Karachi. Inclusion criteria will be children who are between 2 and 5 years of age and have a maternal history of pre-eclampsia. The child’s current weight, height and blood pressure will be recorded. A two-dimensional functional echocardiogram and vascular assessment will be performed to evaluate alterations in cardiac function as well as macrovascular remodelling in these children. Data will be presented as mean±SD, median (IQR) or percentages as appropriate. Independent t-test or Mann-Whitney U test will be used for testing of continuous variables (based on the assumption of normality). A p<0.05 will be used to determine statistical significance.Ethics and disseminationEthical approval has been obtained from AKUH Ethics Review Committee. Findings will be disseminated through scientific publications and project summaries for the participants.

Cardiovascular Dysfunction in Children Exposed to Preeclampsia During Fetal Life

“…Details of the recruitment procedure and outcome measurements have been described in detail in the protocol report. 14 Anthropometric, echocardiographic, and vascular data were obtained from 160 study participants (80 in each group). Briefly, eligible study participants from the exposed and unexposed group were scheduled for study visits.…”

Promoter methylation changes and vascular dysfunction in pre-eclamptic umbilical vein

“…Given this, due to epigenetic code that can be inherited, it put forward the hypothesis that the child with maternal history of PE are with a higher risk of diseases and disorders particularly in vascular problems. Recent cohort studies assessing whether maternal PE are associated with vascular problems in the offspring throughout childhood and early adolescence have provided supportive evidence for this concept [39–42]. Although this study did not investigate the offspring, the interesting finding in epigenetic-mediated umbilical vascular dysfunctions provides new important information for further studies on cardiovascular diseases in fetal origins.…”

Preeclampsia and Fetal Congenital Heart Defects

“…The development of cardiac abnormalities 39 such as increased myocardial wall thickness and concentric remodelling associated to decreased end-diastolic volume 40 , global diastolic dysfunction, low cardiac output and decreased cardiac reserve 52 , increases the rates of arrhythmias, heart failure 59 , coronary and peripheral arterial diseases 60 later in life. They have also an increased risk of stroke 58 , increased BMI 48 , plasma glucose 61 , aIMT and cord blood triglyceride, and decreased cord blood HDL and cholesterol levels, which highlights the possibility of an atherogenic phenotype behind an increased risk of CVD 48 .…”

“…Even adolescents born from preeclamptic mothers showed structural abnormalities 39 such as increased myocardial wall thickness and concentric remodelling associated to decreased enddiastolic volume 40 .…”