Chahinda Ghossein-Doha

Hypertension After Preeclampsia Is Preceded by Changes in Cardiac Structure and Function

Preeclampsia is associated with a 4-fold higher risk for developing remote chronic hypertension. Preeclampsia is accompanied by left ventricular hypertrophy and decreased diastolic function, which may or may not resolve postpartum. We tested the hypothesis that increased measures of cardiac geometry and decreased cardiac function persisting for ≥6 months postpartum in normotensive women with a history of preeclampsia precede the development of later chronic hypertension. Formerly preeclamptic women (n=652) underwent echocardiography at 9 months (range, 6–19) postpartum. We excluded women with preexisting hypertension (n=42), hypertension at the postpartum screening (n=133), and those that did not return any checklist (n=128). Eventually, 349 women were included. Remote health was evaluated by a biennially checklist. We used Cox regression for analysis. Twenty-seven (8%) normotensive women had developed chronic hypertension during a medium follow-up period of 6 years. At screening they differed from their counterparts who remained normotensive by hazard ratio for left ventricular mass index (1.11; 95% confidence interval [CI], 1.03–1.18), diastolic blood pressure (1.13; 95% CI, 1.06–1.20), systolic blood pressure (1.07; 95% CI, 1.02–1.11), mean arterial pressure (1.11; 95% CI, 1.05–1.18), heart rate (1.05; 95% CI, 1.01–1.10), and E/A ratio (0.22; 95% CI, 0.06–0.85). Backward stepwise analysis showed independent hazard ratio for left ventricular mass index and diastolic blood pressure 1.08 (95% CI, 1.01–1.16) and 1.13 (95% CI, 1.06–1.21), respectively. In conclusion, the development of later chronic hypertension in initially normotensive formerly preeclamptic women is preceded by increased left ventricular mass index and diastolic blood pressure at postpartum screening.

Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women

To analyse the predicted 10‐ and 30‐year risk scores for cardiovascular disease (CVD) in patients who experienced preeclampsia (PE) 5–10 years previously compared with healthy parous controls.

Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis

To describe the physiological pattern of gestational plasma volume adjustments in normal singleton pregnancy and compare this with the pattern in pregnancies complicated by pregnancy‐induced hypertension, pre‐eclampsia or fetal growth restriction.OBJECTIVE The aim of this systematic review and meta-analyses was to comprehensively describe the physiological pattern of gestational plasma volume adjustments during human singleton pregnancies and compare this to the pattern of pregnancies complicated by pregnancy-induced hypertension, preeclampsia or fetal growth restriction. METHODS We performed a meta-analysis of the current literature on plasma volume adjustments during physiological and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and Embase (Ovid) databases. Included studies needed to report a reference plasma volume measurement (non-pregnant control group, pre-pregnancy, or post-partum) and plasma volume measurements during a predetermined gestational age. Mean differences between reference and pregnant plasma volume measurements were calculated for predefined intervals of gestational age using random-effects model described by DerSimonian and Laird. RESULTS 30 studies were included for meta-analysis with publication dates ranging from 1934 to 2007. Plasma volume started to increase in the first weeks of pregnancy with the steepest increase during the second trimester. Plasma volume continued to increase in the third trimester with a pooled maximum increase of 1.13 L [1.07; 1.19 L] (45.6% [43.0%; 48.1%]) compared to reference during physiologic pregnancies. The plasma volume expansion in gestational hypertensive and growth restricted complicated pregnancies was 0.80 L [0.59; 1.02 L] (32.3% [23.6%; 41.1%]) in the third trimester and was lower compared to physiologic pregnancies (P<0.0001). CONCLUSIONS During physiological human pregnancy, plasma volume increases on average more than 1 litre as compared to non-pregnant conditions. In pregnancy complicated by pregnancy-induced hypertension, preeclampsia or fetal growth restriction, third trimester plasma volume increase is 13.3% lower.

Pre-eclampsia : an important risk factor for asymptomatic heart failure

Pre‐eclampsia (PE) is associated with both postpartum structural asymptomatic heart disease (i.e. heart failure Stage B (HF‐B)) and conventional cardiovascular (CV) risk factors. We aimed to evaluate the extent to which PE, adjusted for conventional CV risk factors, is associated independently with asymptomatic cardiac abnormalities postpartum.

Maternal metabolic syndrome, preeclampsia, and small for gestational age infancy

OBJECTIVE We sought to explore to what extent the presence of cardiometabolic and cardiovascular risk constitutions differ between pregnancies complicated by small-for-gestational-age (SGA) infancy, preeclampsia (PE), or a combination of both. STUDY DESIGN We conducted a cohort study in women after pregnancies complicated by placental syndrome with fetal manifestations (SGA infancy [n = 113]), maternal manifestations (PE [n = 729]), or both (n = 461). Independent sample t test was used to compare cardiometabolic and cardiovascular risk factors between groups. Logistic regression was used to calculate odds ratios and adjusted odds ratios of the prevalence of the metabolic syndrome and its constituents between groups. Adjustments were made for maternal age, parity, smoking, interval between delivery and measurements, and intrauterine fetal demise. RESULTS The metabolic syndrome was present in 7.5% of women who delivered SGA infants, 15.6% of former PE women, and 19.8% of women after pregnancy complicated by both SGA and PE. Hypertension was observed in 25% of former PE women and 15% of women with solely SGA. Women who delivered a SGA infant had lower global vascular compliance compared to former PE women without SGA. CONCLUSION Cardiometabolic risk factors consistent with metabolic syndrome relate to the maternal rather than to the fetal presentation of placental syndrome. Nonetheless, highest incidence of metabolic syndrome was observed in women with both PE and SGA. PE relates to chronic hypertension, whereas increased arterial stiffness seems to be associated with women who deliver a SGA infant.

Metabolic syndrome after pregnancies complicated by pre-eclampsia or small-for-gestational-age: a retrospective cohort

To study the prevalence of metabolic syndrome in women after a pregnancy complicated by pre‐eclampsia or small‐for‐gestational‐age (SGA), both epitomes of placental syndrome.

Long-Term Risk to Develop Hypertension in Women With Former Preeclampsia: A Longitudinal Pilot Study

Introduction: Women with former preeclampsia (exPE) develop chronic hypertension 4 times more often than healthy parous controls. Women, destined to develop remote chronic hypertension, had increased left ventricular mass index (LVMI) and diastolic blood pressure (BP) prior to the onset of hypertension as compared to those remaining normotensive. However, longitudinal data on the progress of this increased LVMI in women destined to develop hypertension are lacking. Methods: We included 20 women with exPE and 8 parous controls. At both 1- and 14-year postpartum (pp), we performed cardiac ultrasound and determined circulating levels of the metabolic syndrome variables. Of 14-year pp, 7 (35%) former patients had developed chronic hypertension. We compared these 7 former patients with both the 13 former patients who remained normotensive and the 8 parous controls using the Mann-Whitney U test and Kruskal-Wallis analysis. Results: Women with hypertensive exPE differed from their normotensive counterparts by a higher incidence of early-onset preeclampsia (PE) in their index pregnancy and a higher rate of recurrence in next pregnancies. At 1-year pp, they also had high/normal BP and higher fasting insulin levels. At 14 years pp, the relative left ventricular wall thickness was higher, and the E/A ratio was lower, in the hypertensive group relative to those remaining normotensive. Conclusion: Women with exPE are at increased risk of developing chronic hypertension, when (1) the PE in the index pregnancy had an early-onset and/or recurred in next pregnancies and (2) the 1-year pp. Blood pressure was high normal. We also noticed that at 14 years pp, the hypertensive group showed signs of concentric left ventricular remodeling along with a decreased E/A ratio.

Maternal cardiac adaptation to subsequent pregnancy in formerly pre-eclamptic women according to recurrence of pre-eclampsia.

Left‐ventricular remodeling in women with pre‐eclampsia (PE) is concentric rather than eccentric, and tends to persist postpartum, particularly after early‐onset PE. This study was designed to determine whether prepregnancy cardiac geometry and function along with cardiac adaptation to the subsequent pregnancy in former early‐onset PE patients differs between those who do and those who do not develop recurrent PE later on in their second pregnancy.

Prevalence of asymptomatic heart failure in formerly pre-eclamptic women: a cohort study

After pre‐eclampsia (PE), the prevalence of structural heart disease without symptoms, i.e. heart failure Stage B (HF‐B), may be as high as one in four women in the first year postpartum. We hypothesize that a significant number of formerly pre‐eclamptic women with HF‐B postpartum are still in their resolving period and will not have HF‐B during follow‐up.

Cardiac remodeling and pre‐eclampsia: an overview of microRNA expression patterns

Pre‐eclampsia (PE) is strongly associated with heart failure (HF) later in life. During PE pregnancy, the left ventricle undergoes concentric remodeling which often persists after delivery. This aberrant remodeling can induce a molecular signature that can be evaluated in terms of microRNAs (miRNAs) and which may help to explain the associated increased risk of HF. For this review, we performed a literature search of PubMed (National Center for Biotechnology Information), identifying studies on miRNA expression in concentric remodeling and on miRNA expression in PE. The miRNA data were stratified based on origin (isolated from humans or animals and from tissue or the circulation) and both datasets compared in order to generate a list of miRNA expression patterns in concentric remodeling and in PE. The nine miRNAs identified in both concentric remodeling and PE‐complicated pregnancy were: miR‐1, miR‐18, miR‐21, miR‐29b, miR‐30, miR‐125b, miR‐181b, miR‐195 and miR‐499‐5p. We found five of these miRNAs (miR‐18, miR‐21, miR‐125b, miR‐195 and miR‐499‐5p) to be upregulated in both PE pregnancy and cardiac remodeling and two (miR‐1 and miR‐30) to be downregulated in both; the remaining two miRNAs (miR‐29b and miR‐181b) showed upregulation during PE but downregulation in cardiac remodeling. This innovative approach may be a step towards finding relevant biomarkers for complicated pregnancy and elucidating their relationship with remote cardiovascular disease. Copyright