First trimester screening identifies maternal cardiac maladaptation at mid-gestation

BACKGROUND

First, a logistic regression model, based on maternal demographic characteristics and medical history and blood pressure at 11-13 weeks' gestation, can identify about 70% of women who develop future chronic hypertension (CH) in the three years following pregnancy, at screen positive rate of 10%. Second, at mid-gestation women who subsequently develop hypertensive disorders of pregnancy (HDP) have increased peripheral vascular resistance and mild cardiac functional and morphological alterations and these cardiovascular abnormalities persist for at least 2 years after delivery.

OBJECTIVE

To examine whether the use of the first-trimester risk for subsequent development of CH can help to identify women at high risk for cardiovascular maladaptation at mid-gestation.

METHODS

Prospective observational study in 3812 women with singleton pregnancies women attending for a routine hospital visit at 11+0 to 13+6 weeks' gestation and again at 19+1 to 23+3 weeks at King's College Hospital, London, UK between August 2019 and August 2020. The first-trimester visit included recording of maternal demographic characteristics and medical history and measurement of systolic and diastolic blood pressure. At mid-gestation detailed maternal cardiovascular assessment was carried out. The association of risk for development of CH, determined from first-trimester assessment, and cardiovascular indices at mid-gestation was examined.

RESULTS

Women who are at high-risk for development of future CH, compared to those at low-risk, had a higher incidence of hypertensive disorders of pregnancy (HDP). In addition, high-risk women, had reduced systolic and diastolic function at mid-gestation. Among women with HDP, those who were high-risk for future CH, compared to those at low-risk, also had worse cardiac function at mid-gestation.

CONCLUSION

Use of a model for first-trimester prediction of subsequent development of CH can identify women who show evidence of cardiac maladaptation at mid-gestation. Further studies are needed to clarify whether women who screen as high-risk for future CH, compared to those at low-risk, have reduced cardiac function beyond pregnancy. This article is protected by copyright. All rights reserved.

The Role of Adrenomedullin in Cardiovascular Response to Exercise - A Review

Adrenomedullin (ADM), the product of the vascular endothelial and smooth muscle cells, and cardiomyocytes, is considered to be a local factor controlling vascular tone, cardiac contractility and renal sodium excretion. The aim of this article was to review the existing data on the effect of different types of exercise on plasma ADM concentration in healthy men. The results of studies on the effect of dynamic exercise on the plasma ADM are contradictory. Some authors reported an increase in plasma ADM, while others showed a slight decrease or did not observe any changes. The inverse relationship between plasma ADM and mean blood pressure observed during maximal exercise support the concept that ADM might blunt the exercise-induced systemic blood pressure increase. Positive relationships between increases in plasma ADM and those in noradrenaline, atrial natriuretic peptide (ANP) or interleukin-6 observed during prolonged exercise suggest that the sympathetic nervous system and cytokine induction may be involved in ADM release. Increased secretion of ADM and ANP during this type of exercise may be a compensatory mechanism attenuating elevation of blood pressure and preventing deterioration of cardiac function. Studies performed during static exercise have showed an increase in plasma ADM only in older healthy men. Positive correlations between increases in plasma ADM and those in noradrenaline and endothelin-1 may indicate the interaction of these hormones in shaping the cardiovascular response to static exercise. Inverse relationships between exercise-induced changes in plasma ADM and those in cardiovascular indices may be at least partly associated with inotropic action of ADM on the heart. Interactions of ADM with vasoactive peptides, catecholamines and hemodynamic factors demonstrate the potential involvement of this peptide in the regulation of blood pressure and myocardial contractility during exercise.