Maternal Cardiac Function at Midgestation and Development of Preeclampsia

Gibbone, E.; Huluta, Iulia; Wright, Alan; Nicolaides, Kypros H.; Charakida, Marietta

doi:10.1016/j.jacc.2021.10.033

Cited by 21 publications

(17 citation statements)

References 35 publications

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“…Although pregnancy has been thought to act as a natural stress test which can unmask latent cardiovascular disease, the noted cardiac changes were mild and unlikely to be of clinical relevance. In addition, we have reported previously that these cardiac changes do not assist in the prediction of development of these pregnancy complications 6,12 . However, we cannot exclude the possibility that, with the clinical onset of HDP and GDM, the cardiac changes can be accentuated and contribute to the maternal long-term cardiovascular risk.…”

Section: Interpretation Of Results and Comparison With Findings Of Pr...mentioning

confidence: 92%

“…The measured values of MAP, UtA‐PI, PlGF and the cardiovascular indices were converted to multiples of the median (MoM) or deviation from the median (delta) to remove the effects of characteristics such as gestational age, weight, race, method of conception, medical conditions and elements from the obstetric history associated with the individual being measured, as described previously 6 . Similarly, the measured ophthalmic artery PSV ratio was converted to delta.…”

Section: Methodsmentioning

confidence: 99%

“…Epidemiological studies have shown consistently that women with gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are at increased risk of developing adverse cardiovascular events within the first decade after the index pregnancy [1][2][3][4][5] . Following this observation, several research groups have assessed the cardiovascular phenotype of women in pregnancy, aiming to explore the presence of latent disease prior to the development of pregnancy complications [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

“…Echocardiographic studies have demonstrated that, in midgestation, women who are at risk of pre‐eclampsia and those at risk of gestational hypertension have similar cardiovascular phenotype prior to the development of the outcome 6 . Left myocardial deformation was shown to be reduced, as assessed by global longitudinal systolic strain, and there was evidence of increased peripheral vascular resistance, as measured by echocardiography 6 . However, screening studies showed that assessment of these indices offers no significant benefit to routine screening which uses maternal characteristics to identify women at risk of HDP 7 .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study

Anzoategui

Gibbone

Wright

et al. 2022

Ultrasound in Obstet & Gyne

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Objective Women with gestational diabetes mellitus (GDM) and/or hypertensive disorders of pregnancy (HDP) are at increased long‐term cardiovascular risk. Mild cardiac functional alterations have been detected in women with GDM or HDP in midgestation, prior to clinical onset of the disease, but these functional alterations have not been found to be useful as screening tools. In contrast, increased impedance to peripheral blood flow, measured by echocardiography or ophthalmic artery Doppler, has been shown to provide incremental value to maternal characteristics for the prediction of pre‐eclampsia. However, it is unknown whether similar changes can be detected in women at risk of GDM. In this study, we performed detailed cardiovascular phenotyping in a large, unselected population of women in midgestation to identify similarities and differences in cardiovascular adaptation in women who are at risk of GDM and/or HDP. Methods This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included assessment of flow velocity waveforms from the maternal ophthalmic arteries, echocardiography for assessment of maternal cardiovascular function and measurement of uterine artery pulsatility index and serum placental growth factor (PlGF) for assessment of placental perfusion and function. The measured indices were converted to either multiples of the median (MoM) values or deviation from the median (delta) after adjusting for maternal characteristics and elements of medical history. Biomarker delta or MoM values in the GDM and HDP groups were compared with those in the unaffected group using 95% CI and t‐tests. Results The study population of 5214 pregnancies contained 4429 (84.9%) that were unaffected by GDM or HDP, 509 (9.8%) complicated by GDM without HDP, 41 (0.8%) with GDM and HDP, and 235 (4.5%) with HDP without GDM. In HDP cases, with or without GDM, there was evidence of impaired placentation, with a decrease in PlGF, and increased impedance to flow in the peripheral circulation, suggested by an increase in ophthalmic artery peak systolic velocity (PSV) ratio, peripheral vascular resistance assessed on echocardiography and mean arterial pressure. In the GDM group without HDP, there was no evidence of altered placental perfusion or function and ophthalmic artery PSV ratio was not significantly different from that in the unaffected group; peripheral vascular resistance and mean arterial pressure were increased but to a lesser degree than in the HDP group. In the HDP group, there was an increase in global longitudinal systolic strain and slight increase in isovolumic relaxation time, while in the GDM group, there was an increase in mitral valve E/e′, myocardial performance index and global longitudinal systolic strain. Conclusions In midgestation, women who subsequently develop HDP or GDM have a mild subclinical reduction in left ventricular function. In HDP cases, with or without GDM, there is evidence of impaired placentation and al...

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Section: Interpretation Of Results and Comparison With Findings Of Pr...mentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study

Anzoategui

Gibbone

Wright

et al. 2022

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

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“…The two conditions can coexist and, in both, predominant features are impaired placental perfusion and function, characterized by increased UtA-PI and reduced serum PlGF 24,25 . As far as vascular alterations are concerned, increase in peripheral vascular resistance appears to be a consistent feature of hypertensive disorders, but results in SGA are inconclusive 26,27 . For instance, in some studies, peripheral vascular alterations in the mother are found only in the presence of PE, whereas others suggest that this is seen in SGA pregnancies in the absence of hypertensive disorders 28 .…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

Ophthalmic artery Doppler at 19–23 weeks' gestation in pregnancies that deliver small‐for‐gestational‐age neonates

Azim

Wright

Sapantzoglou

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?In mid-gestation, women who deliver a small-forgestational-age (SGA) neonate in the absence of hypertensive disorders, compared to those with uncomplicated pregnancy, have increased ophthalmic artery peak systolic velocity (PSV) ratio, mean arterial pressure and uterine artery pulsatility index and decreased serum placental growth factor. These changes resemble those seen in hypertensive disorders of pregnancy, but they are of smaller magnitude. The second PSV was increased in pre-eclampsia (PE) and gestational hypertension (GH) and, to a lesser extent, in SGA, and the first PSV was increased only in PE and GH but not in SGA. In general, in pathological pregnancies, the magnitude of deviation of biomarkers from unaffected pregnancies was greater for those delivering at < 37 than at ≥ 37 weeks' gestation. What are the clinical implications of this work?Ophthalmic artery Doppler measurement of PSV ratio is likely to be useful in screening not only for hypertensive disorders of pregnancy but also for pregnancies with a SGA neonate.

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Hypertensive disorders of pregnancy and long‐term cardiovascular health: FIGO Best Practice Advice

Poon

Nguyen‐Hoang

Smith

et al. 2023

Intl J Gynecology & Obste

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Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high‐income countries and approximately 25% in low‐ and middle‐income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long‐term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.

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Maternal Cardiac Function at Midgestation and Development of Preeclampsia

Cited by 21 publications

References 35 publications

Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study

Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study

Ophthalmic artery Doppler at 19–23 weeks' gestation in pregnancies that deliver small‐for‐gestational‐age neonates

Hypertensive disorders of pregnancy and long‐term cardiovascular health: FIGO Best Practice Advice

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