Association Between Fetal Congenital Heart Defects and Maternal Risk of Hypertensive Disorders of Pregnancy in the Same Pregnancy and Across Pregnancies

Boyd, Heather A.; Basit, Saima; Behrens, Ida; Leirgul, Elisabeth; Bundgaard, Henning; Wohlfahrt, Jan; Melbye, Mads; Øyen, Nina

doi:10.1161/circulationaha.116.024600

Cited by 78 publications

(90 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In line with Jansen's hypothesis, we believe that not only a subclinical level of placental dysfunction, but also genetic or epigenetic determinants of abnormal embryological neurodevelopment should be investigated to explain abnormal cranial growth in CHDs [14]. Recent studies [6,27,28] gave a potential insight into the connection between impaired fetal growth and CHD, suggesting a common pathway between cardiovascular (angio)genesis and placental function. Interestingly, a Spanish study [29] explored the gene expression profile of Down syndrome fetal heart tissue and found an antiangiogenic profile that was very similar to that found in the CHD fetal heart tissue gene profile.…”

Section: Discussionsupporting

confidence: 58%

Prenatal Growth in Fetuses with Isolated Cyanotic and Non-Cyanotic Congenital Heart Defects

Inversetti¹,

Fesslová²,

Deprest³

et al. 2018

Fetal Diagn Ther

View full text Add to dashboard Cite

Background: Fetal growth may vary significantly in different congenital heart defects (CHDs). Objectives: To investigate prenatal growth of CHD fetuses and its correlation with classifications based upon expected oxygen delivery to the fetal brain or structural findings. Methods: Seventy-nine euploid fetuses with isolated CHD were recruited prospectively and categorized by the expected oxygen supply to the brain (low, intermediate, and high) or by the expected arterial mixing considering two categories (cyanotic or non-cyanotic). Biometry and Doppler were recorded, and Z-scores (Zs) calculated. Growth changes at different time points were analyzed and compared with 150 controls. Results: A total of 664 exams were performed on 229 fetuses. Median head circumference (HC) Zs were lower in all CHD fetuses from the second trimester onwards and in cyanotic CHD fetuses from the first onwards, with associated smaller abdominal circum-ference (AC) in the third trimester (first-trimester biparietal diameter Zs cyanotic: -1.3 [-2.36; -0.98], non-cyanotic -0.72 [-1.25; -0.6], p = 0.044, second-trimester HC Zs cyanotic: -1.47 [-2.3; -0.84]; non-cyanotic -0.45 [-0.83; -0.02], p < 0.0001; AC Zs cyanotic 0.0 [-0.44; 0.86]; non-cyanotic 0.65 [0.31; 1], p = 0.0006). Birth-weight centiles were smaller in CHDs (particularly in cyanotic) with no differences between categories of brain oxygen delivery. Conclusions: Fetuses with cyanotic CHD have fetal growth restriction, impaired head growth, yet normal posterior fossa dimensions and fetal-placental Doppler.

show abstract

Section: Discussionsupporting

confidence: 58%

Prenatal Growth in Fetuses with Isolated Cyanotic and Non-Cyanotic Congenital Heart Defects

Inversetti¹,

Fesslová²,

Deprest³

et al. 2018

Fetal Diagn Ther

View full text Add to dashboard Cite

show abstract

“…While speculative, another explanation for our findings, as well as the general overrepresentation of depression and anxiety diagnosis in ACHD patients, might originate from factors involved in prenatal neurodevelopment, rather than the contemporary hemodynamic effects of having a congenital lesion. We can only hypothesize whether the abnormalities we found, are a consequence of, for example, genetic predisposition or angiogenic imbalance during pregnancy, as ASD were strongly associated with early preterm preeclampsia (OR: 12.0 [CI: 8.96‐16.1]), perhaps affecting the neurodevelopment in the fetal period . Additionally, preterm birth might be a contributing factor, as it have been associated with psychiatric disorders …”

Section: Discussionmentioning

confidence: 89%

“…12.0 [CI: 8.96-16.1]), perhaps affecting the neurodevelopment in the fetal period. 29 Additionally, preterm birth might be a contributing factor, as it have been associated with psychiatric disorders. 30 Although life expectancy is improved over the last decades, patients with ASD, even if small and unrepaired, continue to have an increased mortality risk compared to the reference group.…”

Section: Discussionmentioning

confidence: 99%

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Udholm

Nyboe

Jørgensen

et al. 2019

Congenital Heart Disease

View full text Add to dashboard Cite

Objective For the first time, we wish to assess the psychiatric burden in adult patients living with small, unrepaired atrial septal defects (ASD) using register‐based data, combined with self‐reported measures on levels emotional distress and educational status. Design A descriptive study using both the unique Danish registries and validated psychiatric questionnaires and scales, including: The Symptom Checklist, Whiteley‐7, and Brief Illness Perception Questionnaire. Patients Adult patients with small, unrepaired ASD, diagnosed between 1953 and 2011. Outcome Measures Number of register‐based psychiatric diagnoses. Additionally, symptoms of anxiety, depression, somatization, health anxiety, illness perception, and levels of educational attainment compared to age‐ and gender‐matched individuals from the reference group. Results We identified 723 Danish patients with a small, unrepaired ASD. Approximately 17% of the patients eligible for inclusion had one or more psychiatric diagnoses. The most common diagnoses were neurotic, stress‐related, and somatoform disorders. A total of 140 patients (mean age 33 years) was included for examination of their mental health using psychiatric questionnaires and scales. Patients with small ASD had higher scores of depression and anxiety when compared to the reference group (0.57 ± 0.67 vs 0.39 ± 0.52; P < .001). Furthermore, patients reported more symptoms of somatization (0.51 ± 0.48 vs 0.34 ± 0.39; P < .001). Finally, a higher percentage of patients with an unrepaired ASD had no education beyond high school when compared to the reference group (33.3% vs 14.3%; P < .001) and a smaller proportion of patients had completed a short‐cycle higher education (6.5% vs 16.1%; P = .002). Conclusion Patients with a small, unrepaired ASD in adult life have more symptoms of anxiety, depression, and somatization compared to the reference group. Furthermore, fewer patients had no education beyond high school. These results support the guidelines that adults with small ASD warrants regular lifelong follow‐up in specialized clinics aware of not only adverse somatic outcome but also rates of depression and anxiety.

show abstract

“…There is coincidence of both CHD and preterm PE in about five per 100 000 pregnancies. The epidemiological studies highlighting the association between fetal CHD and PE reported that the increased risk affected mainly the rate of early PE with delivery at < 34 weeks' gestation [6][7][8] . However, the incidence of such early PE in the general population is very low (0.2-0.3%) 7,8 and, even with a seven-fold increased incidence of cases of fetal CHD 8 , the expected incidence in such cases would be only 1-2%.…”

Section: Main Findings Of Studymentioning

confidence: 99%

Impaired placental perfusion and major fetal cardiac defects

Fantasia

Andrade

Syngelaki

et al. 2018

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Objective To investigate the relationship between fetal congenital heart defects (CHD) and placental perfusion assessed by uterine artery pulsatility index (UtA‐PI), in relation to development of pre‐eclampsia (PE). Methods This was a prospective screening study of singleton pregnancies at 19–24 weeks' gestation. Transvaginal ultrasound was used to measure UtA‐PI and the values were converted into multiples of the normal median (MoM). Median MoM values in pregnancies with a fetus with isolated major CHD were compared to those without CHD, in relation to development of PE. Results The 91 407 singleton pregnancies fulfilling the entry criteria included 206 (0.23%) with isolated major fetal CHD and 91 201 without CHD. The prevalence of PE was 4.4% in pregnancies with fetal CHD and 2.7% in those without CHD (relative risk (RR), 1.6 (95% CI, 0.84–3.04); P = 0.150); the respective values for preterm PE with delivery at < 37 weeks' gestation were 2.4% and 0.7% (RR, 3.4 (95% CI, 1.42–8.09); P = 0.006). In the total population, median UtA‐PI MoM was significantly higher in those that developed PE compared to those without PE (1.22 (interquartile range (IQR), 0.94–1.57) vs 1.00 (IQR, 0.84–1.19); P < 0.0001) and, in the PE group, the median UtA‐PI MoM was inversely related to gestational age at delivery (r = −0.458; P < 0.0001). The same pattern of inverse relationship between UtA‐PI MoM and gestational age at delivery with PE was observed in pregnancies with and those without CHD, but, in the CHD group, compared to those without CHD, UtA‐PI was significantly higher both in pregnancies with and in those without PE. Conclusions In pregnancies both with and without fetal CHD that develop PE, impedance to flow in the UtAs is increased and this increase is particularly marked in those with preterm PE. The prevalence of preterm PE is more than three times higher in pregnancies with than those without fetal major CHD, and the prevalence of major CHD in pregnancies with preterm PE is also more than three times higher than in those without PE. However, > 97% of pregnancies with fetal CHD do not develop preterm PE and > 99% of pregnancies with preterm PE are not associated with fetal CHD. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

show abstract

Association Between Fetal Congenital Heart Defects and Maternal Risk of Hypertensive Disorders of Pregnancy in the Same Pregnancy and Across Pregnancies

Abstract: Linked pathophysiological mechanisms may be involved in some congenital heart defects and preterm preeclampsia. The strong associations across pregnancies support a predominantly maternal origin of effect.

Cited by 78 publications

References 27 publications

Prenatal Growth in Fetuses with Isolated Cyanotic and Non-Cyanotic Congenital Heart Defects

Prenatal Growth in Fetuses with Isolated Cyanotic and Non-Cyanotic Congenital Heart Defects

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Impaired placental perfusion and major fetal cardiac defects

Contact Info

Product

Resources

About