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Shinohara S, Yoshihara T, Mochizuki K, Yasuda G, Kasai M, Sunami R. Preeclampsia prediction model using demographic, clinical, and sonographic data in the second trimester of Japanese nulliparous women. J Obstet Gynaecol Res 2024; 50:395-402. [PMID: 38109933 DOI: 10.1111/jog.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
AIM This study aimed to clarify the factors influencing preeclampsia (PE) development in nulliparous Japanese women and to develop a PE prediction model using second trimester sonographic and clinical data readily available to obstetricians. METHODS This historical cohort study examined the obstetric records of nulliparous women who delivered at Yamanashi Prefectural Central Hospital from January 2019 to May 2023. A model was constructed to predict the PE development rate, with a focus on 796 nulliparous women. The assessed outcome was PE, excluding superimposed PE. Data on maternal age, assisted reproductive technology, mean arterial pressure, uterine artery notching, and umbilical artery resistance index were extracted. Multivariable logistic regression analysis was conducted on these five factors. RESULTS The incidence of PE was 4.3% (34/796). Multivariable analysis indicated significant odds ratios for the association of PE with mean arterial pressure (adjusted odds ratio: 1.06, 95% confidence interval: 1.03-1.10) and uterine artery notching (adjusted odds ratio: 6.28, 95% confidence interval: 2.82-14.0) in nulliparous women. The PE prediction formula was established as follows: Probability of PE development (%) = (odds/1 + odds) × 100, odds = ex and x = -11.3 + 0.039 × maternal age (years) + 0.91 × assisted reproductive technology + 0.061 × mean arterial pressure (mmHg) + 1.84 × uterine artery notching + 1.84 × umbilical artery resistance index. The sensitivity and specificity of this model were 58.8% and 84.5%, respectively (area under the curve: 0.79). CONCLUSIONS This study is the first to provide a prediction formula targeting the Japanese population. Our specialized model for nulliparous women could guide obstetricians to educate women regarding the precise prospect of PE development.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Tatsuya Yoshihara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Kana Mochizuki
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Genki Yasuda
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Mayuko Kasai
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Rei Sunami
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
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Company Calabuig AM, Nunez E, Georgiopoulos G, Nicolaides KH, Charakida M, De Paco Matallana C. Three-dimensional echocardiography and strain cardiac imaging in women with pre-eclampsia with follow-up to 6 months postpartum. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:852-859. [PMID: 37550920 DOI: 10.1002/uog.27442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Epidemiological studies have established that women with pre-eclampsia (PE) are at increased long-term cardiovascular risk. Mild cardiac functional changes have been documented during pregnancy in women with PE, but their evolution from presentation to the postpartum period remains poorly defined. The aim of this study was to assess biventricular cardiovascular indices using novel and sensitive two-dimensional and three-dimensional (3D) echocardiographic modalities in pregnancy and to track alterations in both risk factors and cardiovascular indices in the postpartum period. METHODS A total of 59 women with PE were examined at 34 (interquartile range, 31-37) weeks' gestation and at 2-3 days, 3 months and 6 months postpartum. During pregnancy, 118 women with a normotensive pregnancy were also recruited as controls. Biventricular ejection fraction and left ventricular mass were measured by 3D echocardiography. Biventricular global longitudinal strain and strain of the left atrium were assessed using speckle-tracking imaging. RESULTS In women with PE, compared with controls, there was lower left ventricular diastolic function (left atrial reservoir strain, 44.1% vs 49.2%) and increased left ventricular mass index (148 vs 128 g/m2 ), but there was no significant difference in right ventricular functional indices. These alterations in cardiac indices were mostly explained by differences in maternal risk factors. In the postpartum period, most cardiac indices improved by 3 months. Multivariable linear mixed-model analysis demonstrated that this improvement was mostly attributed to reduction in weight and blood pressure. CONCLUSION In women with PE, there is postpartum improvement in cardiac functional and structural indices in parallel with improvement in their risk factor profile. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A M Company Calabuig
- Hospital Clinico Universitario Virgen de la Arrixaca, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - E Nunez
- Hospital Clinico Universitario Virgen de la Arrixaca, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - G Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - C De Paco Matallana
- Hospital Clinico Universitario Virgen de la Arrixaca, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain
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Hunter R, Baird B, Garcia M, Begay J, Goitom S, Lucas S, Herbert G, Scieszka D, Padilla J, Brayer K, Ottens AK, Suter MA, Barrozo ER, Hines C, Bleske B, Campen MJ. Gestational ozone inhalation elicits maternal cardiac dysfunction and transcriptional changes to placental pericytes and endothelial cells. Toxicol Sci 2023; 196:238-249. [PMID: 37695302 PMCID: PMC10682975 DOI: 10.1093/toxsci/kfad092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Ozone (O3) is a criteria air pollutant with the most frequent incidence of exceeding air quality standards. Inhalation of O3 is known to cause lung inflammation and consequent systemic health effects, including endothelial dysfunction. Epidemiologic data have shown that gestational exposure to air pollutants correlates with complications of pregnancy, including low birth weight, intrauterine growth deficiency, preeclampsia, and premature birth. Mechanisms underlying how air pollution may facilitate or exacerbate gestational complications remain poorly defined. The current study sought to uncover how gestational O3 exposure impacted maternal cardiovascular function, as well as the development of the placenta. Pregnant mice were exposed to 1PPM O3 or a sham filtered air (FA) exposure for 4 h on gestational day (GD) 10.5, and evaluated for cardiac function via echocardiography on GD18.5. Echocardiography revealed a significant reduction in maternal stroke volume and ejection fraction in maternally exposed dams. To examine the impact of maternal O3 exposure on the maternal-fetal interface, placentae were analyzed by single-cell RNA sequencing analysis. Mid-gestational O3 exposure led to significant differential expression of 4021 transcripts compared with controls, and pericytes displayed the greatest transcriptional modulation. Pathway analysis identified extracellular matrix organization to be significantly altered after the exposure, with the greatest modifications in trophoblasts, pericytes, and endothelial cells. This study provides insights into potential molecular processes during pregnancy that may be altered due to the inhalation of environmental toxicants.
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Affiliation(s)
- Russell Hunter
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Brenna Baird
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Marcus Garcia
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jessica Begay
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Siem Goitom
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Selita Lucas
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Guy Herbert
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - David Scieszka
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jamie Padilla
- Department of Molecular Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Internal Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kathryn Brayer
- Department of Molecular Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Internal Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Andrew K Ottens
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melissa A Suter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Enrico R Barrozo
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Curt Hines
- Department of Biochemistry & Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Barry Bleske
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Matthew J Campen
- Department of Pharmaceutical Sciences, College of Pharmacy University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Xiang Q, Wei Y, Feng X, Chen S, Zhao Y. Initial establishment and validation of a predictive model for preeclampsia in twin pregnancies based on maternal characteristics and echocardiographic parameters. Acta Obstet Gynecol Scand 2023; 102:1566-1574. [PMID: 37533238 PMCID: PMC10577616 DOI: 10.1111/aogs.14651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/22/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION The primary objective of this study was to evaluate the association between maternal echocardiographic changes and the occurrence of preeclampsia (PE) in twin pregnancies. Additionally, we established and validated a prediction model for PE in twin pregnancies. MATERIAL AND METHODS The first part of this study was retrospective and included data from 854 twin pregnancies that received antenatal care at Peking University Third Hospital from April 2017 to April 2021 (training cohort). Overall, 159 women who underwent transthoracic echocardiography were included in the analysis. To build a predictive model, cardiac findings were compared between normotensive women and those with PE. The model was then validated in a prospective longitudinal cohort (test cohort) that included 109 women with twin pregnancies who underwent two consecutive transthoracic echocardiography examinations during the second and third trimesters. RESULTS Fifty-four normotensive women and 105 women with PE were analyzed in the retrospective cohort that was used to build the model in which later preeclampsia was associated with higher left ventricular mass index (>61 g/m2 ), interventricular septal thickness (>7.87 mm), left atrial anteroposterior diameter (>33.5 mm), mitral inflow late diastolic velocity (A) (>0.685 m/s), ratio of early diastolic velocity (E) and peak early diastolic myocardial velocity of the lateral mitral annulus (>6.5), and lower peak early diastolic myocardial velocity (<13.1 cm/s). The optimized PE prediction model based on the interventricular septal thickness, left atrial anteroposterior diameter, A, peak early diastolic myocardial velocity and pre-pregnancy bodyweight index was then established (area under the curve [AUC] = 0.840, 95% CI 0.778-0.903, P < 0.001). The model was tested in the prospective cohort including 87 normotensive women and 22 women with PE; the validation test showed that the prediction model in the second (AUC = 0.801) and third (AUC = 0.811) trimesters had high discriminative ability and calibration. CONCLUSIONS Maternal echocardiographic changes in twin pregnancies are associated with the development of preeclampsia. The model constructed, based on the echocardiographic parameters and body mass index, provides novel ideas for the prediction of PE.
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Affiliation(s)
- Qianqian Xiang
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
| | - Yuan Wei
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
| | - Xinheng Feng
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Shaomin Chen
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Yangyu Zhao
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
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Garcia-Gonzalez C, Nunez E, Zhang H, Nicolaides KH, Charakida M. Maternal and Offspring Cardiovascular Function following Pregnancy with Hypertensive Disorder. Diagnostics (Basel) 2023; 13:2007. [PMID: 37370902 DOI: 10.3390/diagnostics13122007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) have been associated with increased cardiovascular risk for the mother and her offspring. However, it remains unknown whether cardiovascular changes are present in the postpartum period. METHODS This was a cross-sectional study of women with singleton pregnancies. We recruited 33 women (20 following preeclampsia and 13 following gestational hypertension) and an equal number of women with uncomplicated pregnancy. Conventional and more advanced echocardiographic modalities such as speckle tracking were used to assess maternal and offspring cardiac function at 3-9 months postpartum. RESULTS In women with HDP compared to those without, there was higher mean arterial pressure (mean 92.3 (SD 7.3) vs. 86.8 (8.3) mmHg, p = 0.007), left-ventricular mass indexed for body-surface area (64.5 (10.5) vs. 56.8 (10.03), p < 0.003), and E/e' (3.6 (0.8) vs. 3.1 (0.9), p = 0.022). There were no significant differences between groups in maternal left-ventricular systolic-functional indices and in offspring cardiac function between groups. CONCLUSIONS At 3-9 months postpartum, mothers with HDP had higher blood pressure, higher left-ventricular mass, and reduced left-ventricular diastolic function. However, in their offspring, cardiac function was preserved. These findings suggest that mothers who experienced an HDP would benefit from cardio-obstetric follow-up in the postpartum period.
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Affiliation(s)
- Coral Garcia-Gonzalez
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London SE5 8BB, UK
| | - Elena Nunez
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London SE5 8BB, UK
| | - Huijing Zhang
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London SE5 8BB, UK
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London SE5 8BB, UK
| | - Marietta Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London SE5 8BB, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
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Poon LC, Nguyen-Hoang L, Smith GN, Bergman L, O'Brien P, Hod M, Okong P, Kapur A, Maxwell CV, McIntyre HD, Jacobsson B, Algurjia E, Hanson MA, Rosser ML, Ma RC, O'Reilly SL, Regan L, Adam S, Medina VP, McAuliffe FM. Hypertensive disorders of pregnancy and long-term cardiovascular health: FIGO Best Practice Advice. Int J Gynaecol Obstet 2023; 160 Suppl 1:22-34. [PMID: 36635079 DOI: 10.1002/ijgo.14540] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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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Affiliation(s)
- Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Long Nguyen-Hoang
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pius Okong
- Department of Obstetrics and Gynecology, St Francis Hospital Nsambya, Kampala City, Uganda
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Cynthia V Maxwell
- Maternal Fetal Medicine, Sinai Health and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harold David McIntyre
- Mater Health, University of Queensland, Mater Health Campus, South Brisbane, Queensland, Australia
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Esraa Algurjia
- The World Association of Trainees in Obstetrics & Gynecology, Paris, France.,Elwya Maternity Hospital, Baghdad, Iraq
| | - Mark A Hanson
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
| | - Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | | | - Sumaiya Adam
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Virna P Medina
- Department of Obstetrics and Gynecology, Faculty of Health, Universidad del Valle, Clínica Imbanaco Quirón Salud, Universidad Libre, Cali, Colombia
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Briller JE. Echocardiographic Screening in Hypertensive Pregnancy Disorders. J Am Coll Cardiol 2022; 80:1477-1479. [DOI: 10.1016/j.jacc.2022.08.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
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Anzoategui S, Gibbone E, Wright A, Nicolaides KH, Charakida M. Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:207-214. [PMID: 35502146 DOI: 10.1002/uog.24929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
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 all biomarkers of impedance to peripheral blood flow are consistently increased. In contrast, in the GDM group without HDP, biomarkers of placental function are normal and those of impedance to peripheral blood flow are either marginally increased or not significantly different from those in normal pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Anzoategui
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - E Gibbone
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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9
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Abdel Azim S, Wright A, Sapantzoglou I, Nicolaides KH, Charakida M. Ophthalmic artery Doppler at 19-23 weeks' gestation in pregnancies that deliver small-for-gestational-age neonates. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:52-58. [PMID: 35441758 DOI: 10.1002/uog.24913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES First, to explore hemodynamic differences between pregnancies delivering a small-for-gestational-age (SGA) neonate in the absence of hypertensive disorders and those that develop pre-eclampsia (PE) or gestational hypertension (GH), by comparing the ophthalmic artery peak systolic velocity (PSV) ratio and first (PSV1) and second (PSV2) PSV at 19-23 weeks' gestation, and second, to compare these pregnancies for markers of placental perfusion and function. 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 recording of maternal demographic characteristics and medical history, ultrasound examination for assessment of fetal anatomy and growth, and measurement of maternal ophthalmic artery PSV ratio, PSV1, PSV2, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF). The values of PSV ratio, PSV1, PSV2, MAP, UtA-PI and PlGF were converted to multiples of the median (MoM) or deltas. Mean MoMs or deltas of these biomarkers in the SGA, PE and GH groups were compared with those in the unaffected group. The definition of SGA was birth weight below the 10th percentile in the absence of PE or GH. RESULTS The study population of 5214 pregnancies contained 4375 (83.9%) that were unaffected by SGA, PE or GH, 563 (10.8%) complicated by SGA, 157 (3.0%) with PE and 119 (2.3%) with GH. There were three main findings of the study. First, in the SGA, PE and GH groups, compared with unaffected pregnancies, the PSV ratio delta, PSV2 MoM, MAP MoM and UtA-PI MoM were increased and PlGF MoM was decreased; however, the magnitude of most changes was smaller in the SGA group than in PE and GH groups. Second, in the PE and GH groups, but not in the SGA group, PSV1 MoM was increased. Third, in general, in the pathological pregnancies, the magnitude of deviation of biomarkers from unaffected pregnancies was greater for those delivering at < 37 than at ≥ 37 weeks' gestation. CONCLUSION In mid-gestation, pregnancies that subsequently develop hypertensive disorders and those delivering a SGA neonate, compared with unaffected pregnancies, have abnormal uteroplacental measurements and increased maternal ophthalmic artery PSV ratio. These data suggest similar pathophysiology in the two conditions, with evidence of placental dysfunction and increased peripheral vascular resistance, but the magnitude of abnormalities is greater in hypertensive disorders. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Abdel Azim
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - I Sapantzoglou
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Affiliation(s)
- Laura A Magee
- From the Department of Women and Children's Health, School of Life Course Sciences, King's College London (L.A.M., K.H.N., P.D.), the Institute of Women and Children's Health, King's Health Partners Academic Health Science Centre (L.A.M., P.D.), and the Harris Birthright Research Centre for Fetal Medicine, King's College Hospital (K.H.N.) - all in London
| | - Kypros H Nicolaides
- From the Department of Women and Children's Health, School of Life Course Sciences, King's College London (L.A.M., K.H.N., P.D.), the Institute of Women and Children's Health, King's Health Partners Academic Health Science Centre (L.A.M., P.D.), and the Harris Birthright Research Centre for Fetal Medicine, King's College Hospital (K.H.N.) - all in London
| | - Peter von Dadelszen
- From the Department of Women and Children's Health, School of Life Course Sciences, King's College London (L.A.M., K.H.N., P.D.), the Institute of Women and Children's Health, King's Health Partners Academic Health Science Centre (L.A.M., P.D.), and the Harris Birthright Research Centre for Fetal Medicine, King's College Hospital (K.H.N.) - all in London
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Nunez E, Huluta I, Gallardo Arozena M, Wright A, Nicolaides KH, Charakida M. Maternal cardiac function in twin pregnancy at 19-23 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:627-632. [PMID: 35020248 DOI: 10.1002/uog.24857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To compare maternal cardiovascular indices at 19-23 weeks' gestation between twin and singleton pregnancies and assess the impact of chorionicity on these parameters. METHODS This was a prospective observational study in women with twin pregnancy attending for a hospital visit at 19 + 1 to 24 + 3 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history and maternal cardiovascular assessment. In a previous study of 4795 women with singleton pregnancies at 19-23 weeks' gestation, multivariable linear regression models were fitted between the various cardiovascular indices and elements of maternal characteristics and medical history. In this study, we calculated multiples of the median (MoM) and delta values according to the singleton models and assessed the distributional properties of these MoM and delta values in twin as compared with singleton pregnancies. RESULTS The study population of 155 women with twin pregnancy included 86 dichorionic and 69 monochorionic cases. In general, there was a similar distribution of maternal cardiovascular indices in monochorionic and dichorionic twin pregnancies. In both types of twin pregnancy, compared with singleton pregnancy, there was an increase in isovolumetric relaxation time, left atrial area and myocardial performance index, and a decrease in mitral valve E/A. Left ventricular mass indexed for body surface area and relative wall thickness were also increased in twin compared with singleton pregnancy. The magnitude of the increase in left atrial area was greater in dichorionic compared with monochorionic pregnancies. Additionally, mitral valve E was decreased and left atrial volume was increased in dichorionic but not in monochorionic pregnancies, while isovolumetric contraction time was increased in monochorionic but not in dichorionic pregnancies. Left ventricular myocardial deformation was similar between twin and singleton pregnancies. CONCLUSIONS In twin pregnancies at mid-gestation, maternal systolic and diastolic function is reduced when compared with singletons. The patterns of cardiovascular adaptation are similar between monochorionic and dichorionic pregnancies and resemble those reported in uncomplicated singleton pregnancy later in gestation. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Nunez
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - I Huluta
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Gallardo Arozena
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Florio KL, Grodzinsky A. Cardiovascular Indexes in the Era of Preeclampsia: Prevention or Long-Term Outcome Prediction? J Am Coll Cardiol 2022; 79:63-65. [PMID: 34991790 DOI: 10.1016/j.jacc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Karen L Florio
- Saint Luke's Hospital of Kansas City, Women's and Children's Division, Kansas City, Missouri, USA; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
| | - Anna Grodzinsky
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Mid-America Heart Institute of Saint Luke's Hospital, Kansas City, Missouri, USA
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