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Harville EW, Juonala M, Viikari JSA, Kähönen M, Raitakari OT. Pregnancy complications and later vascular ultrasound measures: A cohort study. Pregnancy Hypertens 2017; 10:171-176. [PMID: 29153673 DOI: 10.1016/j.preghy.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Pregnancy complications predict or even predispose to later cardiovascular disease in the mother. We examined whether pregnancy complications are associated with post-pregnancy measures of endothelial dysfunction and arterial stiffness. STUDY DESIGN Prospective cohort; Data for 847 women female participants in the Cardiovascular Risk in Young Finns study were linked with the national birth registry. Preterm birth (<37weeks), low birthweight (<2500g), small-for-gestational-age (weight <10th percentile for gestational age), and hypertensive disorders of pregnancy were examined as predictors of later vascular measures. MAIN OUTCOME MEASURES Flow-mediated dilatation (FMD), carotid intima-media thickness (IMT), Young's elastic modulus (YEM), and carotid artery distensibility. RESULTS In some analyses, gestational hypertension and pre-eclampsia were associated with increased YEM. Low birthweight was also associated with an increase in IMT, and this increased risk was present prior to the pregnancy. CONCLUSIONS The increased cardiovascular risk in the mother observed after low birthweight and hypertensive disorders may be due to vascular changes, and some of this increased risk may be present before pregnancy.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health, USA.
| | - Markus Juonala
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland; Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jorma S A Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Psychology, Tampere University Hospital and University of Tampere, Finland
| | - Olli T Raitakari
- The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Department of Clinical Physiology, Turku University Hospital, Finland
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Farzan SF, Brickley EB, Li Z, Gilbert-Diamond D, Gossai A, Chen Y, Howe CG, Palys T, Karagas MR. Maternal and infant inflammatory markers in relation to prenatal arsenic exposure in a U.S. pregnancy cohort. ENVIRONMENTAL RESEARCH 2017; 156:426-433. [PMID: 28410520 PMCID: PMC5477637 DOI: 10.1016/j.envres.2017.03.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Accumulating evidence indicates that arsenic (As), a potent environmental toxicant, may increase cardiovascular disease risk and adversely affect endothelial function at high levels of exposure. Pregnancy is a vulnerable time for both mother and child; however, studies examining the association between prenatal As exposure and plasma biomarkers of inflammation and endothelial function in mothers and newborns are lacking. METHODS We examined maternal urinary As levels at gestational weeks 24-28 and levels of inflammatory biomarkers in plasma from 563 pregnant women and 500 infants' cord blood. We assessed a multiplexed panel of circulating inflammatory and endothelial function markers, including tumor necrosis factor alpha (TNFα), monocyte chemoattractant protein 1 (MCP1), intercellular adhesion molecule (ICAM1) and vascular cell adhesion molecule (VCAM1). RESULTS Compared with the bottom tertile, the highest tertile of maternal urinary As during pregnancy was associated with a 145.2ng/ml (95% CI 4.1, 286.3; p=0.04) increase in cord blood ICAM1 and 557.3ng/ml (95% CI -56.4, 1171.1; p=0.09) increase in cord blood VCAM1. Among mothers, the highest tertile of maternal urinary As during pregnancy was related to a 141.8ng/ml (95% CI 26.1, 257.5; p=0.02) increase maternal plasma VCAM1 levels. Urinary As was unrelated to MCP1 or TNFα in maternal plasma and cord blood. In structural equation models, the association between maternal urinary As and infant VCAM was mediated by maternal levels of VCAM (βmediation: 0.024, 95% CI: 0.002, 0.050). CONCLUSION Our observations indicate that As exposure during pregnancy may affect markers of vascular health and endothelial function in both pregnant women and children, and suggest further investigation of the potential impacts on cardiovascular health in these susceptible populations.
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Affiliation(s)
- Shohreh F Farzan
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
| | - Elizabeth B Brickley
- Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH, USA and Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Zhigang Li
- Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH, USA and Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Diane Gilbert-Diamond
- Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH, USA and Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Anala Gossai
- Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH, USA and Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Yu Chen
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Caitlin G Howe
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Thomas Palys
- Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH, USA and Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Margaret R Karagas
- Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH, USA and Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Hillman SL, Kubba T, Williams DJ. Delivery of small-for-gestational-age neonate and association with early-onset impaired maternal endothelial function. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:150-154. [PMID: 27800643 DOI: 10.1002/uog.17342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/20/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Women who have delivered a small-for-gestational-age (SGA) infant are at an increased risk of developing cardiovascular disease (CVD) in later life. Endothelial dysfunction is a subclinical sign of early CVD. It is unknown whether women who have recently had a pregnancy complicated by SGA, in the absence of other maternal and fetal diseases, have subclinical endothelial dysfunction. Our aim was to assess maternal endothelial function 6 months after a pregnancy complicated by SGA. METHODS This was a case-control study conducted in a tertiary referral hospital in London, UK, over a 15-month period. Flow-mediated dilatation (FMD) of the brachial artery was measured in women 6.9 ± 2.5 months after childbirth. Forty-four women were included in the study, of whom 15 had a SGA neonate (mean ± SD customized birth centile of 1.9 ± 2.3) and 29 delivered an appropriately grown baby (mean ± SD customized birth centile of 47.5 ± 26.3). The primary continuous variable, FMD, was assessed in each group and compared using unpaired t-test. RESULTS Women who had a SGA neonate had lower postpartum FMD (6.79 ± 0.95%) than did those who had an appropriately grown offspring (10.26 ± 2.44% (95% CI for difference between groups, -5.37 to -1.57); P = 0.0007). There were no differences in postnatal maternal blood pressure, abdominal circumference, weight and glucose, insulin and lipid profiles between the two groups. CONCLUSIONS Women who had a pregnancy affected by SGA, probably due to placental failure in the absence of pre-eclampsia, have evidence of subclinical endothelial dysfunction within 6 months of childbirth. These women may benefit from lifestyle measures focused on the primary prevention of CVD. Further research in larger populations is needed to ascertain if such postpartum maternal endothelial dysfunction is a pregnancy-induced phenomenon or if it is related to the pre-existing maternal phenotype, and whether it persists long term. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S L Hillman
- Institute for Women's Health, University College London, London, UK
| | - T Kubba
- Institute for Women's Health, University College London, London, UK
| | - D J Williams
- Institute for Women's Health, University College London, London, UK
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4
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Stergiotou I, Bijnens B, Cruz-Lemini M, Figueras F, Gratacos E, Crispi F. Maternal subclinical vascular changes in fetal growth restriction with and without pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:706-712. [PMID: 25678131 DOI: 10.1002/uog.14815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/31/2015] [Accepted: 02/06/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess maternal vascular structure and function in pregnancies complicated by fetal growth restriction (FGR), in women with and without pre-eclampsia (PE) at the time of FGR diagnosis. METHODS We evaluated 124 women with a pregnancy complicated by FGR, of whom 60 had PE and 64 did not, and compared these findings to those of 110 normal women (controls). The group of FGR pregnancies without PE was further subdivided according to gestational age at FGR diagnosis into early onset (< 32 weeks) or late onset (≥ 32 weeks). Maternal carotid intima-media thickness (IMT), blood pressure (BP), carotid artery distensibility (CD), circumferential wall stress (CWS) and inferior vena cava (IVC) collapsibility were assessed by ultrasound at the time of FGR diagnosis. RESULTS Compared to controls, cases of FGR with PE showed increased maternal carotid IMT (0.425 (interquartile range (IQR), 0.381-0.486) vs 0.409 (IQR, 0.386-0.439) mm; P = 0.021), BP (mean, 109 (IQR, 101-117) vs 82 (IQR, 77-89) mmHg; P < 0.001) and CWS (19.7 (IQR, 17.0-22.7) vs 12.2 (IQR, 11.1-13.7) kPa; P < 0.001), and reduced CD (25.3 (IQR, 15.7-35.6) vs 31.9 (IQR, 25.4-41.1) kPa(-1) × 10(-3) ; P = 0.037) and IVC collapsibility indices (0.07 (IQR, 0.06-1.11) vs 0.10 (IQR, 0.06-0.13); P = 0.136). Similarly, compared to controls, in cases of FGR without PE maternal carotid IMT (0.436 (IQR, 0.392-0.476) mm; P = 0.001) and BP (88 (IQR, 81-95) mmHg; P < 0.001) were increased but CD and IVC collapsibility were similar. When analysis was subclassified according to gestational age at diagnosis, IMT and CWS were significantly increased only in early-onset FGR while BP was increased in both groups. CONCLUSION Normotensive women with pregnancy complicated by FGR share some subclinical vascular features with those of women with PE, which further reinforces the notion that, at least in a proportion of cases, there is a common placental disease that influences maternal cardiovascular features.
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Affiliation(s)
- I Stergiotou
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - B Bijnens
- ICREA, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Cruz-Lemini
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacos
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Melchiorre K, Sutherland GR, Liberati M, Thilaganathan B. Maternal Cardiovascular Impairment in Pregnancies Complicated by Severe Fetal Growth Restriction. Hypertension 2012; 60:437-43. [DOI: 10.1161/hypertensionaha.112.194159] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fetal growth restriction and preeclampsia are both conditions of placental etiology and associated to increased risk for the long-term development of cardiovascular disease in the mother. At presentation, preeclampsia is associated with maternal global diastolic dysfunction, which is determined, at least in part, by increased afterload and myocardial stiffness. The aim of this study is to test the hypothesis that women with normotensive fetal growth-restricted pregnancies also exhibit global diastolic dysfunction. This was a prospective case-control study conducted over a 3-year period involving 29 preterm fetal growth-restricted pregnancies, 25 preeclamptic with fetal growth restriction pregnancies, and 58 matched control pregnancies. Women were assessed by conventional echocardiography and tissue Doppler imaging at diagnosis of the complication and followed-up at 12 weeks postpartum. Fetal growth-restricted pregnancies are characterized by a lower cardiac index and higher total vascular resistance index than expected for gestation. Compared with controls, fetal growth-restricted pregnancy was associated with significantly increased prevalence (
P
<0.001) of asymptomatic left ventricular diastolic dysfunction (28% versus 4%) and widespread impaired myocardial relaxation (59% versus 21%). Unlike preeclampsia, cardiac geometry and intrinsic myocardial contractility were preserved in fetal growth-restricted pregnancy. Fetal growth-restricted pregnancies are characterized by a low output, high resistance circulatory state, as well as a higher prevalence of asymptomatic global diastolic dysfunction and poor cardiac reserve. These findings may explain the increased long-term cardiovascular risk in these women who have had fetal growth-restricted pregnancies. Further studies are needed to clarify the postnatal natural history of cardiac dysfunction in these women.
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Affiliation(s)
- Karen Melchiorre
- From the Fetal Maternal Medicine Unit, Departments of Obstetrics and Gynecology (K.M., B.T.), and Cardiology and Cardiothoracic Surgery (K.M., G.R.S.), St Georges Hospital, University of London, London, United Kingdom; Department of Obstetrics and Gynecology (K.M., M.L.), University of Chieti, Chieti, Italy
| | - George Ross Sutherland
- From the Fetal Maternal Medicine Unit, Departments of Obstetrics and Gynecology (K.M., B.T.), and Cardiology and Cardiothoracic Surgery (K.M., G.R.S.), St Georges Hospital, University of London, London, United Kingdom; Department of Obstetrics and Gynecology (K.M., M.L.), University of Chieti, Chieti, Italy
| | - Marco Liberati
- From the Fetal Maternal Medicine Unit, Departments of Obstetrics and Gynecology (K.M., B.T.), and Cardiology and Cardiothoracic Surgery (K.M., G.R.S.), St Georges Hospital, University of London, London, United Kingdom; Department of Obstetrics and Gynecology (K.M., M.L.), University of Chieti, Chieti, Italy
| | - Basky Thilaganathan
- From the Fetal Maternal Medicine Unit, Departments of Obstetrics and Gynecology (K.M., B.T.), and Cardiology and Cardiothoracic Surgery (K.M., G.R.S.), St Georges Hospital, University of London, London, United Kingdom; Department of Obstetrics and Gynecology (K.M., M.L.), University of Chieti, Chieti, Italy
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