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Cardiovascular Dysfunction in Children Exposed to Preeclampsia During Fetal Life
Zahra Hoodbhoy1, Nuruddin Mohammed2, Shafquat Rozi3
1Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
Insights
Children exposed to preeclampsia in utero show altered vascular function, including higher blood pressure and pulse-wave velocity. Early-onset preeclampsia is a key factor, highlighting the need for routine blood pressure screening in these children.
Area of Science:
- Cardiovascular health
- Developmental origins of health and disease (DOHaD)
- Pediatric cardiology
Background:
- The developmental origins of health and disease (DOHaD) hypothesis suggests early-life exposures impact long-term health.
- Preeclampsia is a pregnancy complication that may affect fetal development.
- Understanding the long-term cardiovascular impact of in utero preeclampsia exposure is crucial.
Purpose of the Study:
- To investigate differences in cardiac and vascular structure and function in children exposed to preeclampsia in utero compared to those born to normotensive mothers.
- To test the hypothesis that in utero preeclampsia exposure leads to altered cardiac and vascular outcomes in children.
Main Methods:
- Retrospective cohort study of children aged 2-10 years, comparing those exposed to preeclampsia in utero with an unexposed group (n=80 each).
- Assessment of myocardial morphology and function via echocardiography.
- Measurement of carotid intima-media thickness and pulse-wave velocity.
- Multivariate linear regression and subgroup analysis for early- vs. late-onset preeclampsia.
Main Results:
- Children exposed to preeclampsia had a significantly higher prevalence of stage 1 systolic and diastolic hypertension compared to the unexposed group (22% vs 9% and 35% vs 19%, respectively; P=.01).
- Exposed children exhibited higher pulse-wave velocity (0.42 ± 0.1 vs 0.39 ± 0.1; P=.03).
- Early-onset preeclampsia was primarily associated with observed changes in blood pressure and pulse-wave velocity; no significant differences in cardiac morphology or function were found.
Conclusions:
- In utero exposure to preeclampsia, particularly early-onset disease, impacts vascular function in children aged 2-10 years.
- Routine blood pressure screening is recommended for children with in utero preeclampsia exposure.
- The findings support the DOHaD hypothesis regarding cardiovascular programming after preeclampsia exposure.
Background:
Keeping in view the developmental origin of health and disease hypothesis, the aim of this study was to assess differences in cardiac and vascular structure and function in children exposed to preeclampsia in utero compared with those of normotensive mothers. The hypothesis under investigation was that children exposed to preeclampsia would have altered cardiac and vascular structure and function compared with the unexposed group.
Methods:
This was a retrospective cohort study that included children 2 to 10 years of age born to mothers with and without exposure to preeclampsia in utero (n = 80 in each group). Myocardial morphology and function using echocardiography and carotid intima-media thickness and pulse-wave velocity were determined. Multivariate linear regression was used to compare preeclampsia-exposed and nonexposed groups. Subgroup analysis to assess differences between early- and late-onset preeclampsia was also performed.
Results:
Forty-one percent of mothers (n = 33) had early-onset preeclampsia. Children in the exposed group had a significantly higher prevalence of stage 1 systolic and diastolic hypertension (22% [n = 18] and 35% [n = 18], respectively) compared with the unexposed group (9% [n = 7] and 19% [n = 15], respectively; P = .01). Children in the exposed group also had higher pulse-wave velocity compared with those in the unexposed group (0.42 ± 0.1 vs 0.39 ± 0.1, P = .03). Subgroup analysis revealed that changes in blood pressure and pulse-wave velocity were determined primarily by early-onset preeclampsia. There was no significant difference in cardiac morphology or systolic and diastolic function between the exposed and unexposed groups.
Conclusion:
In utero exposure to preeclampsia has an effect on vascular function in children aged 2 to 10 years, related primarily to early-onset disease. Routine blood pressure screening should be recommended for such children.
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