The Impact of Maternal Gestational Hypertension and the Use of Anti-Hypertensives on Neonatal Myocardial Performance

Abstract

Background: Assessment of myocardial performance in neonates using advanced techniques such as deformation imaging and rotational mechanics has gained considerable interest. The applicability of these techniques for elucidating abnormal myocardial performance in various clinical scenarios is becoming established. We hypothesise that term infants born to mothers with gestational hypertension (GH) may experience impaired performance of the left and right ventricles during the early neonatal period. Objectives: We aimed to assess left and right ventricular (LV and RV) function using echocardiography in infants born to mothers with GH and compare them to a control group. Methods: Term infants (>36⁺⁶ weeks) born to mothers with GH underwent assessment to measure biventricular function using ejection fraction (EF), deformation imaging, left-ventricle rotational mechanics (apical rotation, basal rotation, twist, twist rate, and untwist rate), and right ventricle-specific functional parameters (tricuspid annular plane systolic excursion and fractional area change) in the first 48 h after birth. A control group comprising infants born to healthy mothers was used for comparison. Results: Fifteen infants with maternal GH and 30 age-matched controls were enrolled. The GH infants exhibited no differences in birthweight or LV or RV length, but they had lower EF (54 vs. 61%; p < 0.01), LV global longitudinal strain (-20 vs. -25%; p < 0.01), and LV twist (11 vs. 16°; p = 0.04). There were no differences in any of the RV functional parameters. Conclusion: Infants born to mothers with GH exhibited lower LV function than healthy controls, while RV function appeared to be preserved. This relationship warrants further exploration in a larger cohort.

Maternal Hypertensive Disorders of Pregnancy and Cardiac Structure and Function in the Newborn

“…Studies of the association between maternal preeclampsia or GH and newborn cardiac structure and systolic function assessed by conventional echocardiography are limited and have had small sample sizes (maximum 80 preeclampsia-exposed children). 20 , 21 Breatnach et al 21 found left ventricular systolic dysfunction with significantly lower ejection fraction within 48 hours of birth in infants born at term to mothers with GH, compared with infants born to healthy mothers, which contrasts with our findings of larger fractional shortening in infants exposed to preeclampsia but not in infants exposed to GH. Aye et al 20 found that although left and right ventricular masses were similar at birth in infants born at term after pregnancies with preeclampsia, GH, and no HDP, respectively, right ventricular end-diastolic volume was smaller in infants exposed to HDPs, preeclampsia in particular.…”

Blood pressure variability correlates with right ventricular strain in women with gestational hypertension and preeclampsia

“…Caglar et al reported a significant enlargement of RV and RA, and deterioration of RV systolic and diastolic function in women with preeclampsia comparing with controls [ 19 ]. Some researches reported enlarged RV, increased pulmonary arterial pressure and reduced RV longitudinal strain in patients with pregnancy-induced hypertension [ 6 – 9 ], whereas others did not find significant difference between these patients and normotensive controls [ 10 , 11 ].…”

“…In patients with acute preeclampsia RV global strain was significantly lower than in normotensive controls and this was particularly noticed for basal and apical RV segments [ 6 , 9 ]. Yu et al reported lower RV longitudinal strain in women with preeclampsia than in normotensive controls, [ 3 ], whereas other studies found no difference in RV global longitudinal strain [ 8 , 11 ].…”

“…However, right ventricular (RV) structural, functional, and mechanical changes are still mainly unrevealed. Scarce data are conflicting because some authors reported significant functional changes in terms of increased RV diameter, elevated pulmonary pressure and reduced RV longitudinal mechanics—strain [ 6 – 9 ], whereas other studies demonstrated no difference in RV structure and function between normotensive controls and pregnant women with hypertensive disorders [ 10 , 11 ].…”

Haemodynamic assessment and management of hypotension in the preterm

“…Recent evidence suggests that the maternal use of labetalol for pregnancy-induced hypertension may reduce LV performance at birth. The clinical implications of this phenomenon remain unstudied 42. Endocrine disorders such as adrenal haemorrhage and adrenogenital syndromes result in BP instability and can lead to a fall in both systolic and diastolic BPs.…”