Possible Common Aetiology behind Maternal Preeclampsia and Congenital Heart Defects in the Child: a Cardiovascular Diseases in <scp>N</scp>orway Project Study

Brodwall, Kristoffer; Leirgul, Elisabeth; Greve, Gottfried; Vollset, Stein Emil; Holmstrøm, Henrik; Tell, Grethe S.; Øyen, Nina

doi:10.1111/ppe.12252

Cited by 61 publications

(66 citation statements)

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“…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

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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.

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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

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“…With the aggravation of the disease, the expression of miRNA-376c in patients with severe PE was significantly decreased compared with those in other groups, the fetal weight was small and most fetuses were premature. It has been reported in the literature (24) that the risks of neonatal defect disease and premature delivery are higher in PE patients.…”

Section: Discussionmentioning

confidence: 99%

Expression of miR‑376 in blood of pregnant women with preeclampsia and its effect on 25‑hydroxyvitamin D

Zhan

et al. 2018

Exp Ther Med

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The study aims to investigate the clinical significance of regulating the expression of 25-hydroxyvitamin D (25-OH-VD) via microRNA (miRNA)-376c in the occurrence and development of preeclampsia (PE) in pregnant women. Peripheral blood and placental tissues were collected from pregnant women in 4 groups, including 67 normal pregnant women, 41 pregnant women with gestational hypertension, 40 pregnant women with mild PE and 51 pregnant women with severe PE. The expression of 25-OH-VD and miRNA-376c in peripheral blood were analyzed via reverse transcription-quantitative polymerase chain reaction (RT-qPCR); the protein expression of 25-OH-VD was analyzed via western blotting, and the clinical significance of its expression was also analyzed. The expression of miRNA-376c in peripheral blood in pregnant women was decreased (P<0.01), and the expression of 25-OH-VD in peripheral blood was significantly decreased (P<0.01); there was a significantly positive correlation between the expression of miRNA-376c and 25-OH-VD (P<0.01). There was a significantly positive correlation between miRNA-376c and the protein expression of 25-OH-VD in placental tissues (P<0.01). The downregulation of miRNA-376c expression in peripheral blood and placental tissues in pregnant women had significantly positive correlations with gestational age, plasma albumin level and fetal weight, but had significantly negative correlations with blood pressure and urinary protein level. (P<0.01). The downregulation of 25-OH-VD expression in placental tissues also had such correlations. The low expression of miRNA-376c in PE patients is involved in the occurrence and development of PE through downregulating the expression of 25-OH-VD.

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“…Auger y cols reportaron una asociación significativa entre la PE de inicio temprano y el desarrollo de CC de tipo crítico con una razón de prevalencia de 2,78 (IC95% 1,71-4,50), una diferencia de prevalencia de 249,6 en 100.000 y un RR ajustado de 2,8 (IC95% 1,8-4,4). Por otro lado, Brodwall y cols reportaron que la PE de inicio temprano tanto leve como severa estuvieron asociados con un incremento de riesgo de CC con un RR de 15,5 (IC95% 7,9-30,4) y un RR ajustado de 13,5 (IC95% 6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]8), especialmente con la doble salida del ventrículo derecho (double outlet right ventricle, DORV), síndrome de corazón derecho hipoplásico (hypoplastic right heart síndro-me, HRHS), coartación de la aorta y con defecto del tabique auriculoventricular (atrioventricular septal defect, AVSD); esta última, presente en más del 25% de los casos de PE de inicio temprano severo. Solo se encontró un incremento de riesgo de CC en el grupo de PE severa tardía con un RR de 1,7 (IC95% 1,2-2,4).…”

Section: Discussionunclassified

“…Brodwall y cols (11) limitaron su estudio a casos de CC severa, entre los que se incluyeron: heterotaxia, transposición de grandes vasos, tetralogía de Fallot, DORV, otros defectos conotruncales (estenosis aórtica supravalvular, defecto del tabique ventricular (ventricular septal defects, VSD), tronco arterial común, arco aórtico interrumpido), AVSD, retorno venoso pulmonar anómalo, hipoplasia del corazón izquierdo, estenosis valvular aórtica, HRHS, anomalía de Ebstein. Por otro lado, Auger y cols (10) clasificaron a las CC en críticas y no críticas, incluyendo en el primer grupo: tetralogía de Fallot, transposición de grandes vasos, tronco arterial, hipoplasia del corazón izquierdo, coartación aórtica.…”

Section: Discussionunclassified

Preeclampsia y defecto cardiaco fetal: ¿existe una asociación? Revisión de la evidencia

Silva-Ocas

Galvez-Olortegui

et al. 2016

Rev. chil. obstet. ginecol.

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RESUMENIntroducción: La preeclampsia (PE) es un desorden multisistémico complejo causado por una angiogéne-sis anormal placentaria. La cardiopatía congénita (CC) es uno de los defectos estructurales más comunes en neonatos. Recientemente, diversos estudios han identificado un desequilibrio en los niveles de factores proangiogénicos y antiangiogénicos en sangre umbilical de neonatos con CC similares a los hallados en sangre de mujeres con PE, lo que sugiere una posible asociación. Objetivo: Revisar la evidencia científica disponible sobre la relación entre la PE y el desarrollo de CC en neonatos. Métodos: Se realizó una bús-queda en las bases de datos Scopus y Medline/Pubmed utilizando los términos "pre-eclampsia" y "congenital heart defects", se seleccionaron 4 artículos que relacionaban las variables PE y CC, los cuales fueron revisados a texto completo. Únicamente se encontraron trabajos de tipo observacional analítico (1 estudio de prevalencia, 1 estudio de casos y controles y 2 estudios de cohortes), publicados entre el 2014 y 2016. Resultados: La PE de inicio temprano (<34 semanas) fue el factor de riesgo más importante asociado al desarrollo de CC en neonatos. La severidad de un defecto cardiaco se asocia con la intensidad y el momento de inicio de los desequilibrios en los factores angiogénicos. Conclusión: Encontramos evidencia relevante de la asociación entre PE y CC. La condición hipertensiva y los cambios endoteliales condicionados por ésta, estarían relacionados con el aumento de riesgo para el desarrollo de la CC antes que la exposición a medicamentos antihipertensivos.PALABRAS CLAVES: Preeclampsia, hipertensión inducida en el embarazo, hipertensión, cardiopatía congénita, medicación antihipertensiva SUMMARYIntroduction: Preeclampsia (PE) is a complex multisystem disorder caused by an abnormal placental angiogenesis. Congenital heart disease (CHD) is one of the most common structural defects in newborn infants. Recently, several studies have identified an imbalance in the levels of proangiogenic and antiangiogenic factors in umbilical blood of newborn infants with CHD similar to those found in the blood of women with PE, suggesting a possible association. Objective: To review the available scientific evidence about the relationship between the PE and the development of CHD in newborn infants. Method: A search was conducted in Scopus and Medline/PubMed databases using the terms "pre-eclampsia" and "congenital heart defects". Four articles that linked PE and CHD were selected and reviewed in full text. Only analytical observational

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Possible Common Aetiology behind Maternal Preeclampsia and Congenital Heart Defects in the Child: a Cardiovascular Diseases in Norway Project Study

Cited by 61 publications

References 36 publications

Impaired placental perfusion and major fetal cardiac defects

Impaired placental perfusion and major fetal cardiac defects

Expression of miR‑376 in blood of pregnant women with preeclampsia and its effect on 25‑hydroxyvitamin D

Preeclampsia y defecto cardiaco fetal: ¿existe una asociación? Revisión de la evidencia

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