Placental Findings in Pregnancies Complicated by Maternal Cardiovascular Disease

Wu, Fred; Quade, Bradley J.; Carreon, Chrystalle Katte; Schefter, Zoë J.; Moses, Abigail; Lachtrupp, Cara L.; Markley, John C.; Valente, Anne Marie; Economy, Katherine E.; Aggarwal, Shivani; Aldweib, Nael; Alshawabkeh, Laith; Barker, Nancy D.; Buber, Yonatan; Carabuena, Jean Marie; Carazo, Matthew; Dollar, Emily; Drakeley, Sheila; Duarte, Valeria E.; Easter, Sarah Rae; Assenza, Gabriele Egidy; Graf, Julia; Gurvitz, Michelle; Halpern, Daniel; Harmon, Amy; Hickey, Kelsey; Hynes, Jenna S.; Joyce, Caitlyn; Knapp, William P.; Landzberg, Michael J.; Morgan, Rόisίn B.; Mullen, Mary P.; Opotowsky, Alexander R.; Partington, Sara L.; Pearson, D; Rajpal, Saraubh; Rodríguez-Monserrate, Carla P.; Rouse, Carrie; Shafer, Keri M.; Singh, Michael; Schmidt, Ada C. Stefanescu; Tsao, Allison L.; Upadhyay, Shailendra

doi:10.1016/j.jacadv.2022.100008

Cited by 10 publications

(15 citation statements)

References 33 publications

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“…Additionally, Wu et al found that placentas from pregnancies complicated by maternal CHD, arrhythmia, cardiomyopathy, connective tissue disease, acquired valvular disease, ischemic heart disease, or vascular disease commonly showed evidence of vascular abnormalities 4 . Within the maternal CHD cohort, Wu et al found no differences in anatomic, infectious, in ammatory, or vascular pathology based on anatomic or physiologic classi cation of CHD 4 . Our study similarly found high rates of maternal vascular malperfusion in pregnancies affected by maternal CHD, though no differences were seen in rates of histopathologic evidence of maternal vascular malperfusion based on cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

“…Howell et al showed that maternal obesity results in downregulation of placental VEGF/Flt signaling resulting in decreased placental angiogenesis, placental hypoperfusion, and increased risk for pregnancy complications like SGA and pre-eclampsia 9 . Additionally, Wu et al found that placentas from pregnancies complicated by maternal CHD, arrhythmia, cardiomyopathy, connective tissue disease, acquired valvular disease, ischemic heart disease, or vascular disease commonly showed evidence of vascular abnormalities 4 . Within the maternal CHD cohort, Wu et al found no differences in anatomic, infectious, in ammatory, or vascular pathology based on anatomic or physiologic classi cation of CHD 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, maternal CHD is associated with adverse pregnancy and neonatal outcomes, such as higher rates of preterm birth, small for gestational age (SGA) birth weights, and neonatal mortality 2,3 . Although it remains unclear what mediates the relationship between maternal CHD and these adverse pregnancy and neonatal outcomes, it is biologically plausible that altered placental development and function, as a conduit of the fetomaternal system, drive this outcome 4 .…”

Section: Introductionmentioning

confidence: 99%

“…However, while it is clear that maternal cardiovascular health in uences placental health, there are very few studies investigating the effects of maternal CHD on placental function. Maternal CHD is thought to restrict cardiac output, decreasing blood ow to the placenta, resulting in maternal vascular malperfusion 4,8 . Evidence of maternal vascular malperfusion on histopathological evaluation has been shown in pregnancies with maternal CHD.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

Altendahl¹,

Mok²,

Adinkpayah³

et al. 2022

Preprint

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Congenital heart disease (CHD) in pregnancy is associated with an increased risk of adverse maternal, obstetric, and neonatal outcomes, plausibly through mechanisms involving abnormal placental development and function. This retrospective study aims to elucidate how maternal CHD influences placental health and fetal growth. Demographic and clinical information were collected via electronic medical record review and placentas underwent histopathological evaluation. Fifty-three singleton pregnancies over the study period were included: 23 (43%) participants were classified as lower cardiovascular risk (modified World Health Organization (mWHO) I, II) and 30 (57%) were classified as higher cardiovascular risk (mWHO II-III, III, IV) using the modified WHO classification. 12 participants (23%) had a fetus with small for gestational age (SGA). Maternal vascular malperfusion (53%), placental abruption (11.6%), and evidence of infection (26%) were common in this cohort, with prevalence above baseline risk. Participants with mWHO I or II did not significantly differ in placental findings compared to those with mWHO II-III, III, or IV (p>0.05). In pregnancies with maternal CHD, SGA and histologic evidence of maternal vascular malperfusion, and placental abruption were common, though patients with higher cardiovascular risk (mWHO II-III, III, IV) did not show evidence of worsened placental health or fetal growth compared to those with lower risk (mWHO I, II).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

Altendahl¹,

Mok²,

Adinkpayah³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Additionally, maternal CHD is associated with adverse pregnancy and neonatal outcomes, such as higher rates of preterm birth, small for gestational age (SGA) birth weights, and neonatal mortality 2 , 3 . Although it remains unclear what mediates the relationship between maternal CHD and these adverse pregnancy and neonatal outcomes, it is biologically plausible that altered placental development and function, as a conduit of the feto-maternal system, drive these outcomes 4 .…”

Section: Introductionmentioning

confidence: 99%

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

Altendahl

Mok

Adimkpayah

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Congenital heart disease (CHD) in pregnancy is associated with an increased risk of adverse maternal, obstetric, and neonatal outcomes, plausibly through mechanisms involving abnormal placental development and function. This retrospective study aims to elucidate how maternal CHD influences placental health. Demographic and clinical information were collected via electronic medical record review, and placentas underwent histopathological evaluation. Fifty-three singleton pregnancies were included: 35 participants (66%) were classified as lower cardiovascular risk (modified World Health Organization Classification (mWHO) I, II, II-III), and 18 (34%) were classified as higher cardiovascular risk (mWHO III, IV). 12 participants (23%) had a fetus with small for gestational age (SGA). Maternal vascular malperfusion (53%) and placental abruption (11.6%) were common in this cohort, with prevalence above baseline risk. Participants at higher cardiovascular risk had higher rates of SGA (p = 0.04), subchorionic hematomas (p = 0.01) and birth weight:placental weight < 10th percentile (p = 0.04), but did not differ in rates of maternal vascular malperfusion (p = 0.15) compared to those at lower cardiovascular risk. In pregnancies with maternal CHD, SGA and histologic evidence of maternal vascular malperfusion and placental abruption were common, though patients at higher cardiovascular risk did not show evidence of worsened placental health compared to those at lower risk.

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Addressing Social Determinants of Health in Maternal Cardiovascular Health

Mehta,

Spitz,

Sharma

et al. 2024

Canadian Journal of Cardiology

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Placental Findings in Pregnancies Complicated by Maternal Cardiovascular Disease

Cited by 10 publications

References 33 publications

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

Addressing Social Determinants of Health in Maternal Cardiovascular Health

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