Cardiovascular Risk Factors in Offspring of Preeclamptic Pregnancies—Systematic Review and Meta-Analysis

Andraweera, Prabha H.; Lassi, Zohra S

doi:10.1016/j.jpeds.2018.12.008

Cited by 73 publications

(73 citation statements)

References 61 publications

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“…1 University of Helsinki, Finland; 2 National Institute for Health and Welfare, Helsinki, Finland; 3 University of Edinburgh, United Kingdom; 4 Erasmus Medical Center, Rotterdam, the Netherlands; 5 University of Turku, Finland; 6 University of Helsinki and Helsinki University Hospital, Finland; 7 Hyvinkää Hospital, Finland; 8 Oulu University Hospital and University of Oulu, Finland; 9 Norwegian University for Science and Technology, Trondheim, Norway; 10 University of Tampere, Finland.…”

Section: Data Supplement Maternal Hypertensive Pregnancy Disorders Anmentioning

confidence: 99%

“…1-2 They are key risk factors for maternal mortality, 1-2 stillbirth, 1,3 preterm birth 1, 3 and intrauterine growth restriction (IUGR), 3 and predict cardiovascular morbidity in the mother and her offspring. [1][2][3][4] Increasing evidence suggests that the offspring risk is not confined to perinatal and cardiovascular health. Rather, maternal hypertensive pregnancy disorders also predict increased offspring risk of mental disorders, psychiatric symptoms and neurodevelopmental problems.…”

Section: Introductionmentioning

confidence: 99%

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Maternal Hypertensive Pregnancy Disorders and Mental Disorders in Children

et al. 2020

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The associations of maternal hypertensive pregnancy disorders with offspring mental disorders remain unclear. We examined whether maternal hypertensive disorders and maximum blood pressure during pregnancy predict offspring childhood mental disorders, whether the associations are independent of maternal and paternal mental disorders and paternal hypertensive disorders, independent of or additive with maternal early pregnancy overweight/obesity and diabetes mellitus disorders, and mediated or moderated by preterm birth, small-for-gestational-age birth and neonatal intensive care unit admission. Our prospective study comprised 4743 mother-child dyads of Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study. Women were recruited to the study in early pregnancy at Finnish maternity hospitals. Children were born 2006 to 2010 and followed-up until December 31, 2016, to ages 6.4 to 10.8 years. Hypertensive pregnancy disorders were identified from medical records, Medical Birth Register, and Care Register for Health Care. Systolic and diastolic blood pressure were measured at antenatal clinics and hospital visits. Mental disorder diagnoses were identified from Care Register for Health Care. Maternal gestational and chronic hypertension, preeclampsia and its severity increased offspring hazard of any childhood mental disorder. The associations of preeclampsia (hazard ratio=1.66 [95% CI, 1.14–2.42]) and severe preeclampsia (hazard ratio=2.01 [95% CI, 1.08–3.73]) were independent of all covariates. Maternal hypertensive and diabetes mellitus disorders and overweight/obesity also additively increased offspring hazard of mental disorders. Preterm and small-for-gestational-age births and neonatal intensive care unit admission partially mediated the effects of any and severe preeclampsia on offspring mental disorders. To conclude, maternal hypertensive pregnancy disorders carry adverse consequences for offspring mental health.

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Section: Data Supplement Maternal Hypertensive Pregnancy Disorders Anmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maternal Hypertensive Pregnancy Disorders and Mental Disorders in Children

et al. 2020

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“…Further, the risk of HDP is elevated following ART , Thomopoulos et al, 2013, Opdahl et al, 2015, Maheshwari et al, 2018, not least in frozen cycles, thus ART might also be a potential risk factor for the development of CVD in the offspring. A meta-analysis including 36 studies on 53,000 individuals showed that in utero exposure to preeclampsia was associated with a 5.17 mm Hg higher mean systolic and 4.06 mm Hg higher mean diastolic blood pressure as well as a slightly higher (0.36 kg/m 2 ) mean BMI in children and young adults (Andraweera and Lassi, 2019). Both elevated blood pressure and changes in body composition have been found after ART in a few studies (Ceelen et al, 2009, Scherrer et al, 2015, Meister et al, 2018 and summarized in systematic reviews and meta-analyses (Hart andNorman, 2013, Guo et al, 2017).…”

Section: Cardiovascular Risksmentioning

confidence: 99%

Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

et al. 2019

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STUDY QUESTION Is transfer of vitrified blastocysts associated with higher perinatal and maternal risks compared with slow-frozen cleavage stage embryos and fresh blastocysts? SUMMARY ANSWER Transfer of vitrified blastocysts is associated with a higher risk of preterm birth (PTB) when compared with slow-frozen cleavage stage embryos and with a higher risk of a large baby, hypertensive disorders in pregnancy (HDPs) and postpartum hemorrhage (PPH) but a lower risk of placenta previa when compared with fresh blastocysts. WHAT IS KNOWN ALREADY Transfer of frozen-thawed embryos (FETs) plays a central role in modern fertility treatment, limiting the risk of ovarian hyperstimulation syndrome and multiple pregnancies. Following FET, several studies report a lower risk of PTB, low birth weight (LBW) and small for gestational age (SGA) yet a higher risk of fetal macrosomia and large for gestational age (LGA) compared with fresh embryos. In recent years, the introduction of new freezing techniques has increased treatment success. The slow-freeze technique combined with cleavage stage transfer has been replaced by vitrification and blastocyst transfer. Only few studies have compared perinatal and maternal outcomes after vitrification and slow-freeze and mainly in cleavage stage embryos, with most studies indicating similar outcomes in the two groups. Studies on perinatal and maternal outcomes following vitrified blastocysts are limited. STUDY DESIGN, SIZE, DURATION This registry-based cohort study includes singletons born after frozen-thawed and fresh transfers following the introduction of vitrification in Sweden and Denmark, in 2002 and 2009, respectively. The study includes 3650 children born after transfer of vitrified blastocysts, 8123 children born after transfer of slow-frozen cleavage stage embryos and 4469 children born after transfer of fresh blastocysts during 2002–2015. Perinatal and maternal outcomes in singletons born after vitrified blastocyst transfer were compared with singletons born after slow-frozen cleavage stage transfer and singletons born after fresh blastocyst transfer. Main outcomes included PTB, LBW, macrosomia, HDP and placenta previa. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained from the CoNARTaS (Committee of Nordic ART and Safety) group. Based on national registries in Sweden, Finland, Denmark and Norway, the CoNARTaS cohort includes all children born after ART treatment in public and private clinics 1984–2015. Outcomes were assessed with logistic multivariable regression analysis, adjusting for the country and year of birth, maternal age, body mass index, parity, smoking, parental educational level, fertilisation method (IVF/ICSI), single embryo transfer, number of gestational sacs and the child’s sex. MAIN RESULTS AND THE ROLE OF CHANCE A higher risk of PTB (<37 weeks) was noted in the vitrified blastocyst group compared with the slow-frozen cleavage stage group (adjusted odds ratio, aOR [95% CI], 1.33 [1.09–1.62]). No significant differences were observed for LBW (<2500 g), SGA, macrosomia (≥4500 g) and LGA when comparing the vitrified blastocyst with the slow-frozen cleavage stage group. For maternal outcomes, no significant difference was seen in the risk of HDP, placenta previa, placental abruption and PPH in the vitrified blastocyst versus the slow frozen cleavage stage group, although the precision was limited. When comparing vitrified and fresh blastocysts, we found higher risks of macrosomia (≥4500 g) aOR 1.77 [1.35–2.31] and LGA aOR 1.48 [1.18–1.84]. Further, the risks of HDP aOR 1.47 [1.19–1.81] and PPH aOR 1.68 [1.39–2.03] were higher in singletons born after vitrified compared with fresh blastocyst transfer while the risks of SGA aOR 0.58 [0.44–0.78] and placenta previa aOR 0.35 [0.25–0.48] were lower. LIMITATIONS, REASONS FOR CAUTION Since vitrification was introduced simultaneously with blastocyst transfer in Sweden and Denmark, it was not possible to explore the effect of vitrification per se in this study. WIDER IMPLICATIONS OF THE FINDINGS The results from the change of strategy to vitrification of blastocysts are reassuring, indicating that the freezing technique per se has no major influence on the perinatal and maternal outcomes. The higher risk of PTB may be related to the extended embryo culture rather than vitrification. STUDY FUNDING/COMPETING INTEREST(S) The study is part of the ReproUnion Collaborative study, co-financed by the European Union, Interreg V ÖKS. The study was also financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (LUA/ALF 70940), Hjalmar Svensson Research Foundation and NordForsk (project 71 450). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER ISRCTN11780826.

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“…We recently conducted a systematic review and meta-analysis of prospective and retrospective studies that had compared CVD risk factors among those exposed to PE in utero compared to those not exposed to PE in utero. 9 This pooled evidence from 36 studies and over 53,000 participants found that systolic blood pressure, diastolic blood pressure and body mass index (BMI) were significantly higher among those exposed to PE in utero compared to those not exposed to PE in utero. 9 The link between maternal PE and offspring CVD is likely to be due to abnormalities in vascular function.…”

Section: Introductionmentioning

confidence: 99%

“…9 This pooled evidence from 36 studies and over 53,000 participants found that systolic blood pressure, diastolic blood pressure and body mass index (BMI) were significantly higher among those exposed to PE in utero compared to those not exposed to PE in utero. 9 The link between maternal PE and offspring CVD is likely to be due to abnormalities in vascular function. This is supported by the finding of impaired vascular responses in some offspring animal models that mimic PE 10 as well as the majority of human studies of those exposed to PE in utero.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms linking exposure to preeclampsia in utero and the risk for cardiovascular disease

Gatford

Care

Bianco‐Miotto

et al. 2020

J Dev Orig Health Dis

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Preeclampsia (PE) is now recognised as a cardiovascular risk factor for women. Emerging evidence suggests that children exposed to PE in utero may also be at increased risk of cardiovascular disease (CVD) in later life. Individuals exposed to PE in utero have higher systolic and diastolic blood pressure and higher body mass index (BMI) compared to those not exposed to PE in utero. The aim of this review is to discuss the potential mechanisms driving the relationship between PE and offspring CVD. Exposure to an adverse intrauterine environment as a consequence of the pathophysiological changes that occur during a pregnancy complicated by PE is proposed as one mechanism that programs the fetus for future CVD risk. Consistent with this hypothesis, animal models of PE where progeny have been studied demonstrate causality for programming of offspring cardiovascular health by the preeclamptic environment. Shared alleles between mother and offspring, and shared lifestyle factors between mother and offspring provide alternate pathways explaining associations between PE and offspring CVD risk. In addition, adverse lifestyle habits can also act as second hits for those programmed for increased CVD risk. PE and CVD are both multifactorial diseases and, hence, identifying the relative contribution of PE to offspring risk for CVD is a very complex task. However, considering the emerging strong association between PE and CVD, those exposed to PE in utero may benefit from targeted primary CVD preventive strategies.

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Cardiovascular Risk Factors in Offspring of Preeclamptic Pregnancies—Systematic Review and Meta-Analysis

Cited by 73 publications

References 61 publications

Maternal Hypertensive Pregnancy Disorders and Mental Disorders in Children

Maternal Hypertensive Pregnancy Disorders and Mental Disorders in Children

Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

Mechanisms linking exposure to preeclampsia in utero and the risk for cardiovascular disease

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