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Published on: January 26, 2024
Effect of Maternal Preeclampsia on Cardiac Structure and Function in Very Low Birth Weight Infants
GoleNaz A Kohbodi1, Rowena G Cayabyab1, Rutuja N Kibe1
1Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California.
Insights
Infants exposed to severe preeclampsia (PE) show altered hemodynamics, including higher blood pressure and vascular resistance, but no cardiac hypertrophy. These findings are crucial for managing very low birth weight (VLBW) infants born to mothers with PE.
Area of Science:
- Neonatal Cardiology
- Perinatal Medicine
- Pediatric Cardiology
Background:
- Severe maternal preeclampsia (PE) is a significant complication of pregnancy.
- The impact of maternal PE on the cardiovascular health of very low birth weight (VLW) infants requires further investigation.
Purpose of the Study:
- To determine if exposure to severe maternal preeclampsia (PE) is associated with hypertrophic cardiac changes and altered hemodynamics in very low birth weight (VLBW) infants.
Main Methods:
- A case-control study compared VLBW infants exposed to maternal PE with matched controls.
- Echocardiograms were performed within the first 7 days of life.
- Hemodynamic data, placental pathology, and clinical outcomes were collected and analyzed.
Main Results:
- No significant anatomical cardiac changes were observed between groups.
- Infants exposed to PE had higher blood pressure, lower ejection fraction, and reduced fractional shortening.
- Exposed infants exhibited higher systemic and pulmonary vascular resistance and were more likely to be small for gestational age with smaller placentas.
Conclusions:
- Infants born to mothers with PE demonstrate altered hemodynamics, including elevated vascular resistance and reduced cardiac function, without cardiac hypertrophy.
- These findings highlight the cardiovascular impact of maternal PE on VLBW infants and should inform clinical management strategies.
Objective:
We aimed to determine whether exposure to severe maternal preeclampsia (PE) in very low birth weight (VLBW) infants is associated with hypertrophic cardiac changes and altered hemodynamics.
Study Design:
Case-control study of VLBW infants born at Los Angeles General Medical Center from May 2015 to August 2023, who had an echocardiogram within the first 7 days of life. Cases were infants exposed to maternal PE and controls were infants not exposed to maternal PE matched by birth weight (BW) 1:1. Laboratory, placental pathology results, hemodynamic data and clinical outcomes were collected and compared between cases and control infants.
Results:
A total of 43 cases matched by BW with control infants were studied. There were no significant anatomical cardiac changes by echocardiography between cases and control infants. Cases had significantly higher blood pressure within the first 72 hours of life and lower ejection fraction (EF), fractional shortening, and peak systolic flow velocity through their patent ductus arteriosus (PDA) within the first week of life. Cases were more likely to be smaller despite being born at a later gestational age (GA), as well as small for GA with placental weight less than 10th percentile compared to control infants.
Conclusion:
Our findings indicate that infants born to mothers with PE have higher systemic vascular resistance as evidenced by elevated blood pressure, and lower EF and shortening fraction and higher pulmonary vascular resistance as evidenced by lower peak flow velocity through the PDA. We did not observe hypertrophic cardiac changes in exposed infants. These findings should be considered in clinical decision-making during management of these infants.
Key Points:
· VLBW infants exposed to severe PE have higher rate of Small for gestational age and smaller placentas.. · VLBW infants exposed to severe PE have higher systemic vascular resistance during transitional period and lower EF and fractional shortening.. · VLBW infants exposed to severe PE have higher pulmonary vascular resistance..
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