Pregnancy as a critical window for blood pressure regulation in mother and child: programming and reprogramming

Abstract

Pregnancy is a critical time for long-term blood pressure regulation in both mother and child. Pregnancies complicated by placental insufficiency, resulting in pre-eclampsia and intrauterine growth restriction, are associated with a threefold increased risk of the mother to develop hypertension later in life. In addition, these complications create an adverse intrauterine environment, which programmes the foetus and the second generation to develop hypertension in adult life. Female offspring born to a pregnancy complicated by placental insufficiency are at risk for pregnancy complications during their own pregnancies as well, resulting in a vicious circle with programmed risk for hypertension passing from generation to generation. Here, we review the epidemiology and mechanisms leading to the altered programming of blood pressure trajectories after pregnancies complicated by placental insufficiency. Although the underlying mechanisms leading to hypertension remain the subject of investigation, several abnormalities in angiotensin sensitivity, sodium handling, sympathetic activity, endothelial function and metabolic pathways are found in the mother after exposure to placental insufficiency. In the child, epigenetic modifications and disrupted organ development play a crucial role in programming of hypertension. We emphasize that pregnancy can be viewed as a window of opportunity to improve long-term cardiovascular health of both mother and child, and outline potential gains expected of improved preconceptional, perinatal and post-natal care to reduce the development of hypertension and the burden of cardiovascular disease later in life. Perinatal therapies aimed at reprogramming hypertension are a promising strategy to break the vicious circle of intergenerational programming of hypertension.

High Fat Diets Sex-Specifically Affect the Renal Transcriptome and Program Obesity, Kidney Injury, and Hypertension in the Offspring

“…Additionally, maternal and post-weaning HF increased several sodium transporters in the female kidney, including NHE3, NCC, and NKCC2. Given that most sodium transporters are clock-controlled genes [47], and that increased expression of sodium transporters triggers programmed hypertension in various models [8,48], our observations suggest HF-induced disturbed circadian clock may induce sodium transporters to trigger sodium retention, contributing to the development of hypertension in females. However, whether HF-induced programming of kidney disease in males attributed to dysregulated RAS and sodium transporters deserve further elucidation.…”

Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy

“…These guidelines describe HDP as ‘failed stress test’, which might unmask subclinical vascular or metabolic disease. Therefore, pregnancy might be a ‘window of opportunity’ for physicians to identify women with increased risk of CVD and improve their cardiovascular health 8. Furthermore, two recent papers reported that up to 30% of women with HDP develop chronic hypertension after pregnancy and advocated close after-pregnancy surveillance by their physician9 10 in line with the Dutch recommendation 6…”

Complementary medicine in preeclampsia care

“…Paauw ve ark. 'nın (5) preeklampsisi/eklampsisi olan kadınların hemşirelik bakımı gereksinimi ile ilgili yaptıkları çalışmada, bu kadınların bakımının belirli bir hemşirelik bakımı gerektirdiği ve hemşirelerin bakımlarını bilimsel kanıta dayalı bakım protokolleri doğrultusunda yapmaları gerektiği vurgulanmıştır. Preeklampsi gebede, psiko-duygusal durumu, psikopatolojik belirtileri ve uyku düzenini olumsuz yönde etkilemektedir.…”