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Stanford AH, Reyes M, Rios DR, Giesinger RE, Jetton JG, Bischoff AR, McNamara PJ. Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction. J Clin Med 2021; 10:jcm10194519. [PMID: 34640535 PMCID: PMC8509219 DOI: 10.3390/jcm10194519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022] Open
Abstract
Neonatal hypertension has been increasingly recognized in premature infants with bronchopulmonary dysplasia (BPD); of note, a sub-population of these infants may have impaired left ventricular (LV) diastolic function, warranting timely treatment to minimize long term repercussions. In this case series, enalapril, an angiotensin-converting enzyme (ACE) inhibitor, was started in neonates with systemic hypertension and echocardiography signs of LV diastolic dysfunction. A total of 11 patients were included with birth weight of 785 ± 239 grams and gestational age of 25.3 (24, 26.1) weeks. Blood pressure improvement was noticed within 2 weeks of treatment. Improvement in LV diastolic function indices were observed with a reduction in Isovolumic Relaxation Time (IVRT) from 63.1 ± 7.2 to 50.9 ± 7.4 msec and improvement in the left atrium size indexed to aorta (LA:Ao) from1.73 (1.43, 1.88) to 1.23 (1.07, 1.29). Neonatal systemic hypertension is often underappreciated in ex-preterm infants and may be associated with important maladaptive cardiac changes with long term implications. It is biologically plausible that identifying and treating LV diastolic dysfunction in neonates with systemic hypertension may have a positive modulator effect on cardiovascular health in childhood and beyond.
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Affiliation(s)
- Amy H. Stanford
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Melanie Reyes
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Danielle R. Rios
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Regan E. Giesinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Jennifer G. Jetton
- Division of Pediatric Nephrology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA;
| | - Adrianne R. Bischoff
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Patrick J. McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
- Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
- Correspondence: ; Tel.: +1-319-467-7435
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2
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Barnard CR, Peters M, Sindler AL, Farrell ET, Baker KR, Palta M, Stauss HM, Dagle JM, Segar J, Pierce GL, Eldridge MW, Bates ML. Increased aortic stiffness and elevated blood pressure in response to exercise in adult survivors of prematurity. Physiol Rep 2021; 8:e14462. [PMID: 32562387 PMCID: PMC7305240 DOI: 10.14814/phy2.14462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/12/2020] [Accepted: 04/26/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Adults born prematurely have an increased risk of early heart failure. The impact of prematurity on left and right ventricular function has been well documented, but little is known about the impact on the systemic vasculature. The goals of this study were to measure aortic stiffness and the blood pressure response to physiological stressors; in particular, normoxic and hypoxic exercise. Methods Preterm participants (n = 10) were recruited from the Newborn Lung Project Cohort and matched with term‐born, age‐matched subjects (n = 12). Aortic pulse wave velocity was derived from the brachial arterial waveform and the heart rate and blood pressure responses to incremental exercise in normoxia (21% O2) or hypoxia (12% O2) were evaluated. Results Aortic pulse wave velocity was higher in the preterm groups. Additionally, heart rate, systolic blood pressure, and pulse pressure were higher throughout the normoxic exercise bout, consistent with higher conduit artery stiffness. Hypoxic exercise caused a decline in diastolic pressure in this group, but not in term‐born controls. Conclusions In this first report of the blood pressure response to exercise in adults born prematurely, we found exercise‐induced hypertension relative to a term‐born control group that is associated with increased large artery stiffness. These experiments performed in hypoxia reveal abnormalities in vascular function in adult survivors of prematurity that may further deteriorate as this population ages.
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Affiliation(s)
| | - Matthew Peters
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Amy L Sindler
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Emily T Farrell
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Kim R Baker
- Department of Cardiology, University of Wisconsin, Madison, WI, USA
| | - Mari Palta
- Department of Population Health, University of Wisconsin, Madison, WI, USA
| | - Harald M Stauss
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - John M Dagle
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Jeffrey Segar
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Marlowe W Eldridge
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA.,The John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin, Madison, WI, USA.,Department of Kinesiology, University of Wisconsin, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
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3
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Huang W, Zhou J, Guo J, Hu W, Chen G, Li B, Wen Y, Jiang Y, Fu K, Bi H, Zhang Y, Wang H. Dexamethasone induces an imbalanced fetal-placental-maternal bile acid circulation: involvement of placental transporters. BMC Med 2021; 19:87. [PMID: 33827559 PMCID: PMC8028715 DOI: 10.1186/s12916-021-01957-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The use of prenatal dexamethasone remains controversial. Our recent studies found that prenatal dexamethasone exposure can induce maternal intrahepatic cholestasis and have a lasting adverse influence on bile acid (BA) metabolism in the offspring. The purpose of this study was to investigate the effects of dexamethasone on fetal-placental-maternal BA circulation during the intrauterine period, as well as its placental mechanism. METHODS Clinical data and human placentas were collected and analyzed. Pregnant Wistar rats were injected subcutaneously with dexamethasone (0.2 mg/kg per day) from gestational day 9 to 20. The metabolomic spectra of BAs in maternal and fetal rat serum were determined by LC-MS. Human and rat placentas were collected for histological and gene expression analysis. BeWo human placental cell line was treated with dexamethasone (20-500 nM). RESULTS Human male neonates born after prenatal dexamethasone treatment showed an increased serum BA level while no significant change was observed in females. Moreover, the expression of organic anion transporter polypeptide-related protein 2B1 (OATP2B1) and breast cancer resistance protein (BCRP) in the male neonates' placenta was decreased, while multidrug resistance-associated protein 4 (MRP4) was upregulated. In experimental rats, dexamethasone increased male but decreased female fetal serum total bile acid (TBA) level. LC-MS revealed that primary BAs were the major component that increased in both male and female fetal serum, and all kinds of BAs were significantly increased in maternal serum. The expression of Oatp2b1 and Bcrp were reduced, while Mrp4 expression was increased in the dexamethasone-treated rat placentas. Moreover, dexamethasone increased glucocorticoid receptor (GR) expression and decreased farnesoid X receptor (FXR) expression in the rat placenta. In BeWo cells, dexamethasone induced GR translocation into the nucleus; decreased FXR, OATP2B1, and BCRP expression; and increased MRP4 expression. Furthermore, GR was verified to mediate the downregulation of OATP2B1, while FXR mediated dexamethasone-altered expression of BCRP and MRP4. CONCLUSIONS By affecting placental BA transporters, dexamethasone induces an imbalanced fetal-placental-maternal BA circulation, as showed by the increase of primary BA levels in the fetal serum. This study provides an important experimental and theoretical basis for elucidating the mechanism of dexamethasone-induced alteration of maternal and fetal BA metabolism and for exploring early prevention and treatment strategies.
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Affiliation(s)
- Wen Huang
- Department of Obstetrics and Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan, 430071, China
| | - Jin Zhou
- Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan, 430071, China
| | - Juanjuan Guo
- Department of Obstetrics and Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan, 430071, China
| | - Wen Hu
- Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan, 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan, 430071, China
| | - Guanghui Chen
- Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan, 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan, 430071, China
| | - Bin Li
- Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan, 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan, 430071, China
| | - Yajie Wen
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
| | - Yimin Jiang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
| | - Kaili Fu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
| | - Huichang Bi
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China.
| | - Yuanzhen Zhang
- Department of Obstetrics and Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. .,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan, 430071, China.
| | - Hui Wang
- Department of Obstetrics and Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. .,Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan, 430071, China. .,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan, 430071, China.
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4
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Bates ML, Levy PT, Nuyt AM, Goss KN, Lewandowski AJ, McNamara PJ. Adult Cardiovascular Health Risk and Cardiovascular Phenotypes of Prematurity. J Pediatr 2020; 227:17-30. [PMID: 32931771 DOI: 10.1016/j.jpeds.2020.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA; Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Anne Monique Nuyt
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Kara N Goss
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Patrick J McNamara
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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5
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Lombardo P, Nguyen VB, Flores TJ, Sutherland MR, Nitsos I, Allison BJ, Parkington H, Tare M, Harding R, De Matteo R, Schneider M, Polglase GR, Black MJ. Early impact of moderate preterm birth on the structure, function and gene expression of conduit arteries. Exp Physiol 2020; 105:1256-1267. [PMID: 32436635 DOI: 10.1113/ep088117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/19/2020] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? What is the immediate impact of moderate preterm birth on the structure and function of major conduit arteries using a pre-clinical sheep model? What is the main finding and its importance? Postnatal changes in conduit arteries, including a significant decrease in collagen within the thoracic aortic wall (predominately males), narrowed carotid arteries, reduced aortic systolic blood flow, and upregulation of the mRNA expression of cell adhesion and inflammatory markers at 2 days of age in preterm lambs compared to controls, may increase the risk of cardiovascular impairment in later life. ABSTRACT The aim of this work was to compare the structure and function of the conduit arteries of moderately preterm and term-born lambs and to determine whether vascular injury-associated genes were upregulated. Time-mated ewes were induced to deliver either preterm (132 ± 1 days of gestation; n = 11 females and n = 10 males) or at term (147 ± 1 days of gestation; n = 10 females and n = 5 males). Two days after birth, ultrasound imaging of the proximal ascending aorta, main, right and left pulmonary arteries, and right and left common carotid arteries was conducted in anaesthetized lambs. Lambs were then killed and segments of the thoracic aorta and left common carotid artery were either snap frozen for real-time PCR analyses or immersion-fixed for histological quantification of collagen, smooth muscle and elastin within the medial layer. Overall there were few differences in vascular structure between moderately preterm and term lambs. However, there was a significant decrease in the proportion of collagen within the thoracic aortic wall (predominantly in males), narrowing of the common carotid arteries and a reduction in peak aortic systolic blood flow in preterm lambs. In addition, there was increased mRNA expression of the cell adhesion marker P-selectin in the thoracic aortic wall and the pro-inflammatory marker IL-1β in the left common carotid artery in preterm lambs, suggestive of postnatal vascular injury. Early postnatal differences in the function and structure of conduit arteries and evidence of vascular injury in moderately preterm offspring may place them at greater risk of cardiovascular impairment later in life.
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Affiliation(s)
- Paul Lombardo
- Department of Medical Imaging and Radiation Sciences, Monash University, Victoria, Clayton, Australia
| | - Vivian B Nguyen
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Tracey J Flores
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Megan R Sutherland
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Ilias Nitsos
- The Ritchie Centre, Department of Obstetrics & Gynaecology, Monash University and Hudson Institute of Medical Research, Victoria, Clayton, Australia
| | - Beth J Allison
- The Ritchie Centre, Department of Obstetrics & Gynaecology, Monash University and Hudson Institute of Medical Research, Victoria, Clayton, Australia
| | - Helena Parkington
- Department of Physiology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Marianne Tare
- Department of Physiology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Richard Harding
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Robert De Matteo
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Victoria, Clayton, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Department of Obstetrics & Gynaecology, Monash University and Hudson Institute of Medical Research, Victoria, Clayton, Australia
| | - M Jane Black
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
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6
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Le B, Sutherland MR, Black MJ. Maladaptive structural remodelling of the heart following preterm birth. CURRENT OPINION IN PHYSIOLOGY 2018. [DOI: 10.1016/j.cophys.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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7
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Ozmen A, Unek G, Korgun ET. Effect of glucocorticoids on mechanisms of placental angiogenesis. Placenta 2017; 52:41-48. [DOI: 10.1016/j.placenta.2017.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 12/12/2022]
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8
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Nguyen VB, De Matteo R, Harding R, Stefanidis A, Polglase GR, Black MJ. Experimentally Induced Preterm Birth in Sheep Following a Clinical Course of Antenatal Betamethasone: Effects on Growth and Long-Term Survival. Reprod Sci 2016; 24:1203-1213. [DOI: 10.1177/1933719116681514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vivian B. Nguyen
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Robert De Matteo
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Richard Harding
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Aneta Stefanidis
- Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Graeme R. Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - M. Jane Black
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
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9
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DeFreitas MJ, Katsoufis CP, Abitbol CL. Cardio-renal consequences of low birth weight and preterm birth. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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10
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Bensley JG, De Matteo R, Harding R, Black MJ. The effects of preterm birth and its antecedents on the cardiovascular system. Acta Obstet Gynecol Scand 2016; 95:652-63. [PMID: 26918772 DOI: 10.1111/aogs.12880] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/09/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Preterm birth occurs in approximately 10% of all births worldwide. It prematurely exposes the developing cardiovascular system to the hemodynamic transition that occurs at birth and to the subsequent functional demands of life ex utero. This review describes the current knowledge of the effects of preterm birth, and some of its common antecedents (chorioamnionitis, intra-uterine growth restriction, and maternal antenatal corticosteroid administration), on the structure of the myocardium. MATERIAL AND METHODS A thorough literature search was conducted for articles relating to how preterm birth, and its antecedents, affect development of the heart. Given that sheep are an excellent model for the studies of cardiac development, this review has focused on experimental studies in sheep as well as clinical findings. RESULTS Our review of the literature demonstrates that individuals born preterm are at an increased risk of cardiovascular disease later in life, including increased mean arterial pressure, abnormally shaped and sub-optimally performing hearts and changes in the vasculature. The review highlights how antenatal corticosteroids, intra-uterine growth restriction, and exposure to chorioamnionitis also have the potential to impact cardiac growth in the preterm newborn. CONCLUSIONS Preterm birth and its common antecedents (antenatal corticosteroids, intra-uterine growth restriction, and chorioamnionitis) have the potential to adversely impact cardiac structure immediately following birth and in later life.
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Affiliation(s)
- Jonathan G Bensley
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
| | - Robert De Matteo
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
| | - Richard Harding
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
| | - Mary J Black
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
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Abstract
In patients born with congenital heart disease, dilatation of the aorta is a frequent feature at presentation and during follow-up after surgical intervention. This review provides an overview of the pathologies associated with aortopathy, and discusses the current knowledge on pathophysiology, evolution, and treatment guidelines of the aortic disease associated with congenital heart defects.
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Affiliation(s)
- Katrien Francois
- Department of Cardiac Surgery, University Hospital Gent, De Pintelaan, Gent, Belgium
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12
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Abstract
Investigations into how perinatal growth and intrauterine environment may 'programme' risk of later cardiovascular disease have been ongoing for over two decades. One of the more recent outcomes of these studies is the observation that certain pregnancy-related conditions, such as preterm birth, have an unusually large impact on the long-term cardiovascular health of the offspring. In the present paper, we review the current literature of how preterm birth affects the long-term cardiovascular structure and function of the offspring, considering three major areas of investigation: firstly, outlining the long-term cardiovascular phenotypic changes in preterm-born individuals; secondly, investigating factors related to preterm birth that may be modifying cardiovascular phenotype, such as preeclampsia, perinatal interventions, and physiological disturbances; and thirdly, the expected clinical relevance of these cardiovascular changes. This review discusses the importance of continued research focused on the mechanistic understanding of these cardiovascular alterations in order to develop specific primary prevention strategies.
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13
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Is late-preterm birth a risk factor for hypertension in childhood? Eur J Pediatr 2014; 173:751-6. [PMID: 24374732 DOI: 10.1007/s00431-013-2242-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED Late-preterm birth is associated with higher rates of neonatal morbidity and mortality and higher health care utilization, but its impact on later life is not well known. In this study, we aimed to evaluate whether late-preterm birth affects blood pressure, renal function, and urinary protein excretion in children later in life. Sixty-five children aged 4 to 13 years born as late-preterm and 65 age- and sex-matched children born full term were evaluated with 24-h ambulatory blood pressure monitoring (ABPM), urinary microalbumin excretion (UAE), and glomerular filtration rate (GFR). All subjects underwent ABPM prospectively. For each gender, daytime, nighttime, and 24-h systolic and diastolic and mean blood pressures (SBP, DBP, and MAP) were transformed to standard deviation scores (SDS). Blood pressure profiles (SBP DBP, and MAP) were considered abnormal when the corresponding SDS values exceeded 1.63. Urinary microalbumin excretion was expressed as milligrams per day, and the value between 30 and 300 mg/day was defined as microalbuminuria (MA). There was no significant difference in the mean GFR and MA levels between late-preterm and term children. 24-h systolic BP SDS, daytime systolic BP SDS, nighttime systolic BP SDS, 24-h diastolic BP SDS, nighttime diastolic BP SDS, 24-h MAP BP SDS, daytime MAP BP SDS, and nighttime MAP BP SDS were found to be significantly higher in late-preterm children compared to term children. CONCLUSION We conclude that late-preterm children have higher BP levels, so those children should be followed up carefully by the pediatrician regarding probable hypertension in their future life.
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14
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Huyard F, Yzydorczyk C, Castro MM, Cloutier A, Bertagnolli M, Sartelet H, Germain N, Comte B, Schulz R, DeBlois D, Nuyt AM. Remodeling of aorta extracellular matrix as a result of transient high oxygen exposure in newborn rats: implication for arterial rigidity and hypertension risk. PLoS One 2014; 9:e92287. [PMID: 24743169 PMCID: PMC3990546 DOI: 10.1371/journal.pone.0092287] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 02/20/2014] [Indexed: 12/22/2022] Open
Abstract
Neonatal high-oxygen exposure leads to elevated blood pressure, microvascular rarefaction, vascular dysfunction and arterial (aorta) rigidity in adult rats. Whether structural changes are present in the matrix of aorta wall is unknown. Considering that elastin synthesis peaks in late fetal life in humans, and early postnatal life in rodents, we postulated that transient neonatal high-oxygen exposure can trigger premature vascular remodelling. Sprague Dawley rat pups were exposed from days 3 to 10 after birth to 80% oxygen (vs. room air control) and were studied at 4 weeks. Blood pressure and vasomotor response of the aorta to angiotensin II and to the acetylcholine analogue carbachol were not different between groups. Vascular superoxide anion production was similar between groups. There was no difference between groups in aortic cross sectional area, smooth muscle cell number or media/lumen ratio. In oxygen-exposed rats, aorta elastin/collagen content ratio was significantly decreased, the expression of elastinolytic cathepsin S was increased whereas collagenolytic cathepsin K was decreased. By immunofluorescence we observed an increase in MMP-2 and TIMP-1 staining in aortas of oxygen-exposed rats whereas TIMP-2 staining was reduced, indicating a shift in the balance towards degradation of the extra-cellular matrix and increased deposition of collagen. There was no significant difference in MMP-2 activity between groups as determined by gelatin zymography. Overall, these findings indicate that transient neonatal high oxygen exposure leads to vascular wall alterations (decreased elastin/collagen ratio and a shift in the balance towards increased deposition of collagen) which are associated with increased rigidity. Importantly, these changes are present prior to the elevation of blood pressure and vascular dysfunction in this model, and may therefore be contributory.
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Affiliation(s)
- Fanny Huyard
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Catherine Yzydorczyk
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Michele M. Castro
- Departments of Pediatrics & Pharmacology, Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Anik Cloutier
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Mariane Bertagnolli
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Hervé Sartelet
- Sainte-Justine University Hospital Research Center, Department of Pathology, Université de Montréal, Montreal, Québec, Canada
| | - Nathalie Germain
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Blandine Comte
- Unit of Human Nutrition UMR 1019, INRA, Research Centre of Clermont-Ferrand/Theix, Saint-Genès-Champanelle, France
| | - Richard Schulz
- Departments of Pediatrics & Pharmacology, Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Denis DeBlois
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Anne Monique Nuyt
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
- * E-mail:
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15
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Abbasalizadeh S, Pharabar ZN, Abbasalizadeh F, Ghojazadeh M, Goldust M. Efficacy of betamethasone on the fetal motion and biophysical profile and amniotic fluid index in preterm fetuses. Pak J Biol Sci 2014; 16:1569-73. [PMID: 24511702 DOI: 10.3923/pjbs.2013.1569.1573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The term ofpreterm birth is used to define the premature neonates considering pregnancy age. In less than 34 week pregnancies, corticosteroids are prescribed to promote embryos' lung maturity. The presents study aimed at evaluating effects of betamethasone injection on feeling embryo motion by mother and index and biophysical profile in preterm pregnancies. In a descriptive-analytical study, 40 pregnant women with the pregnancy age of 30-34 weeks were evaluated. Embryo motion and index and biophysical profile of the amniotic fluid were checked before prescription of double dosage of muscular betamethasone (12 mg) at a 24 h time interval. The injection was repeated for 24 and 48 h after the first injection. The resulted outcomes were compared with those results related to before betamethasone injection. In this study, there was statistically meaningful relationship between embryo motions before injection of betamethasone and 12 h after its injection (p = 0.03). Also, there was a significant relationship between embryo motions 24 and 48 h after injection of betamethasone (p = 0.001). In other words, the embryo motions decreased 12 h after injection of betamethasone. They were improved 48 h after betamethasone injection. But, index and biophysical profile results of amniotic fluid were left unchanged. Application of betamethasone leads to evident but transient decrease in embryo motions. Although motion element of index and biophysical profile of amniotic fluid which is one of the tests used in evaluating the embryo health is fixed and normal, it can be concluded that injection of betamethasone may not affect embryo health.
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Affiliation(s)
| | | | | | - Morteza Ghojazadeh
- Department of Physiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamad Goldust
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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16
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Sutherland MR, Bertagnolli M, Lukaszewski MA, Huyard F, Yzydorczyk C, Luu TM, Nuyt AM. Preterm Birth and Hypertension Risk. Hypertension 2014; 63:12-8. [DOI: 10.1161/hypertensionaha.113.01276] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Megan R. Sutherland
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Mariane Bertagnolli
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Marie-Amélie Lukaszewski
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Fanny Huyard
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Catherine Yzydorczyk
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Thuy Mai Luu
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Anne Monique Nuyt
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
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17
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Repeat antenatal steroid exposure and later blood pressure, arterial stiffness, and metabolic profile. J Pediatr 2013; 163:711-6. [PMID: 23651768 DOI: 10.1016/j.jpeds.2013.03.074] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 02/20/2013] [Accepted: 03/26/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the relationship between repeat courses of antenatal corticosteroids (ACS) and risk factors for cardiovascular disease in adolescents and young adults. STUDY DESIGN We assessed body mass index, blood pressure, arterial stiffness, blood lipids, and insulin resistance (IR) in a Swedish population-based cohort (n = 100) at a median age of 18 (range 14-26) years. Fifty-eight subjects (36 males) had been exposed to 2-9 weekly courses of antenatal betamethasone and 42 (23 males) were unexposed subjects matched for age, sex, and gestational age (GA). RESULTS There were no significant differences between the groups regarding body mass index, systolic or diastolic blood pressures, arterial stiffness measured by augmentation index, blood lipids, IR, or morning cortisol levels either in simple regression or in multivariable models. However, more subjects with elevated augmentation index had been exposed to repeat courses of ACS (n = 7) compared with unexposed subjects (n =1, P = .06), and glucose, insulin, and IR correlated inversely to GA at start of ACS (P < .01). CONCLUSIONS Repeat courses of ACS did not correlate to adverse cardiovascular risk profile in adolescence and young adulthood, but long-standing effects on the arterial tree and glucose metabolism, the latter dependent on GA at ACS exposure, cannot be excluded. These observations have clinical implications for the ongoing discussion on short-term benefits and long-term safety of repeat ACS treatment.
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18
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Black MJ, Sutherland MR, Gubhaju L, Kent AL, Dahlstrom JE, Moore L. When birth comes early: Effects on nephrogenesis. Nephrology (Carlton) 2013; 18:180-2. [DOI: 10.1111/nep.12028] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Mary Jane Black
- Department of Anatomy and Developmental Biology; Monash University; Melbourne; Victoria
| | - Megan R Sutherland
- Department of Anatomy and Developmental Biology; Monash University; Melbourne; Victoria
| | - Lina Gubhaju
- Department of Anatomy and Developmental Biology; Monash University; Melbourne; Victoria
| | - Alison L Kent
- Departments of Neonatology; Canberra Hospital and the Australian National University Medical School
| | - Jane E Dahlstrom
- Anatomical Pathology; Canberra Hospital and the Australian National University Medical School; Canberra; Australian Capital Territory
| | - Lynette Moore
- Department of Surgical Pathology; South Australia Pathology; Women's and Children's Hospital, North Adelaide and The University of Adelaide; Adelaide; South Australia; Australia
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