Cardiac maladaptation in obese pregnant women at term

Buddeberg, B; Sharma, Rajan; O’Driscoll, Jamie M; Agten, Andrea Kaelin; Khalil, Asma; Thilaganathan, B.

doi:10.1002/uog.20170

Cited by 36 publications

(40 citation statements)

References 42 publications

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“…When the maternal cardiovascular system fails to adequately supply the uteroplacental unit, placental hypoperfusion might lead to fetal growth disorders and/or maternal hypertension [ 27 ]. Impaired maternal cardiovascular system reported in conditions such as obesity, chronic hypertension or diabetes can boost this mechanism as showed by a higher BMI in the HDP group compared to the controls in our cohort [ 28 ].…”

Section: Discussionmentioning

confidence: 97%

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

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et al. 2020

JCM

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Studies have reported controversial findings on the association between fetal growth restriction (FGR) or intertwin weight discordance and the risk of hypertensive disorders of pregnancy (HDP) in twin pregnancies. The aim of this study was to investigate the association between twin growth disorders and HDP. Twin pregnancies resulting in two live births at St George’s Hospital between 2000 and 2019 were included. FGR or small-for-gestational-age (SGA) at birth was assessed using singleton and twin reference charts. Intertwin discordance [(large birthweight − small birthweight)/(large birthweight) × 100%)] was calculated. Logistic regression models were performed. SGA (aOR 2.34, 95% CI 1.60–3.44, p < 0.001), intertwin discordance ≥25% (aOR 2.10, 95% CI 1.26–3.49, p = 0.004) and their co-existence (aOR 2.03, 95% CI 1.16–3.54, p = 0.013) were significantly associated with HDP. After adjusting for the known maternal risk factors of HDP and the intertwin discordance, SGA (using the twin charts) was the strongest independent risk factor associated with HDP (aOR 2.12, 95% CI 1.40–3.22, p < 0.001) and preeclampsia (aOR 2.34, 95% CI 1.45–3.76, p < 0.001). This study highlights that the presence of at least one SGA twin is significantly associated with HDP during pregnancy. Therefore, maternal blood pressure should be closely monitored in twin pregnancies complicated by SGA with or without intertwin discordance.

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Section: Discussionmentioning

confidence: 97%

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

Giorgione

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et al. 2020

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“…In contrast, very little is known about the impact of short-term hyperglycemia on the heart in women with GDM. There is a lack of prospective studies examining how GDM influences maternal cardiac adaptation to the increasing cardiovascular demands of pregnancy [8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Impact of gestational diabetes mellitus on maternal cardiac adaptation to pregnancy

Buddeberg

Sharma

O’Driscoll

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To determine whether maternal cardiac adaptation at term differs between women with, and those without, gestational diabetes mellitus (GDM). Methods This was a prospective case–control study of pregnant women at term with or without GDM. For both cases and controls, only women without any comorbidity or form of pre‐existing diabetes who had a singleton pregnancy without complication (such as pre‐eclampsia or fetal growth restriction) were included. All women underwent conventional and speckle‐tracking echocardiography to assess both the left‐ and right‐heart geometry and function. Results A total of 40 women with GDM and 40 healthy controls were enrolled. Women with GDM, compared with controls, had a significantly higher heart rate (83 ± 10 vs 75 ± 9 beats per min; P < 0.001), left ventricular (LV) relative wall thickness (0.43 ± 0.07 vs 0.37 ± 0.08; P < 0.001), LV early diastolic transmitral valve velocity (E) (0.80 ± 0.15 vs 0.73 ± 0.12 m/s; P = 0.026) and LV late diastolic transmitral valve velocity (A) (0.65 ± 0.13 vs 0.57 ± 0.11 m/s; P = 0.006). In women with GDM compared with controls, speckle‐tracking analysis revealed a significant reduction in LV global longitudinal strain (GLS) (−16.29 ± 2.26 vs −17.61 ± 1.89; P = 0.012), LV endocardial GLS (−18.50 ± 2.59 vs −19.84 ± 2.35; P = 0.031) and LV epicardial GLS (−14.40 ± 2.01 vs −15.73 ± 1.66; P = 0.005). Right ventricular (RV) analysis revealed a reduced pulmonary acceleration time (58 ± 10 vs 66 ± 11 ms; P = 0.001) and RV E/A ratio (1.13 ± 0.18 vs 1.29 ± 0.35; P = 0.017), as well as a higher RV myocardial systolic annular velocity (0.16 ± 0.04 vs 0.14 ± 0.02; P = 0.023) and peak late diastolic transtricuspid valve velocity (0.46 ± 0.1 m/s vs 0.39 ± 0.08 m/s; P = 0.001), in women with GDM compared to controls. Conclusions Our findings show that even a short period of exposure to hyperglycemia, as occcurs in women with GDM, is associated with significant maternal functional cardiac impairment at term. Given these findings, further study of postnatal maternal cardiovascular recovery after GDM pregnancy is warranted. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…; Budderberg et al . ). As maternal cardiovascular dysfunction occurs acutely and at the end of pregnancy, late preeclampsia is only infrequently associated with fetal growth restriction – placental dysfunction is short lived and rarely results in fetal growth restriction (Verlohren et al .…”

Section: Cardiorenal Interactions In the Pathophysiology Of Preeclampsiamentioning

confidence: 97%

“…; Buddeberg et al . ,b). It is still to be elucidated whether maternal endothelium dysfunction prior to conception is a prerequisite for development of preeclampsia, or whether sometimes this complication results from an imbalanced mother‐conceptus communication during implantation, a process involving numerous cellular, molecular and biochemical mechanisms such as angiogenetic factors (Boeldt & Bird, ; Nejabati et al .…”

Section: Cardiorenal Interactions In the Pathophysiology Of Preeclampsiamentioning

confidence: 99%

Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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It is generally accepted today that there are two different types of preeclampsia: an early‐onset or placental type and a late‐onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early‐ than in late‐onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation‐induced worsening of subclinical pre‐existing chronic cardiovascular dysfunction in early‐onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late‐onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

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Cardiac maladaptation in obese pregnant women at term

Cited by 36 publications

References 42 publications

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

Impact of gestational diabetes mellitus on maternal cardiac adaptation to pregnancy

Preeclampsia: a gestational cardiorenal syndrome

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