Maternal Cardiovascular System Research Articles

Impact of gestational risk factors on maternal cardiovascular system.

Scarce evidence is available on the potential cardiovascular abnormalities associated with some common gestational complications. We aimed to analyze the potential maternal cardiac alterations related to gestational complications, including body mass index (BMI) >25 kg/m(2), gaining excessive weight, or developing antenatal depression. The design of this study was a secondary analysis of a randomized controlled trial. Echocardiography was performed to assess cardiovascular indicators of maternal hemodynamic, cardiac remodeling and left ventricular (LV) function in 59 sedentary pregnant women at 20 and 34 weeks of gestation. Starting pregnancy with a BMI >25 kg/m(2), gaining excessive weight, and developing antenatal depression had no cardiovascular impact on maternal health (P value >0.002). Depressed women were more likely to exceed weight gain recommendations than non-depressed women (P value <0.002). The evaluated gestational complications seem not to induce cardiovascular alterations in hemodynamic, remodeling and LV function indicators. However, developing antenatal depression increases the risk of an excessive weight gain. This finding is potentially important because excessive weight gain during pregnancy associates with a higher risk of cardiovascular diseases (CVD) later in life.

Preconception Counseling for Women with Congenital Heart Disease.

With advances that have been made over the recent decades in transcatheter and surgical interventions, most patients with congenital heart disease (CHD) can survive into adulthood. Overall, probably half of these surviving patients are female. When these female CHD patients reach childbearing age, however, pregnancy management will be a major issue. In order to meet the demands of fetal growth, the maternal cardiovascular system starts a series of adaptations beginning in early pregnancy. These adaptations include: decreased systemic and pulmonary vascular resistances, decreased blood pressure, expansion of the blood volume, increased heart rate and increased cardiac output. For women with CHD, this hemodynamic alteration may increase the risks of adverse cardiovascular events as well as the fetal and neonatal complications. Therefore, proper risk stratification and effective counseling for women with CHD who are planning their pregnancies is an important undertaking. Congenital heart disease; Pregnancy.

Genome-Wide Identification of Epigenetic Hotspots Potentially Related to Cardiovascular Risk in Adult Women after a Complicated Pregnancy.

BackgroundThe physiological demands of pregnancy on the maternal cardiovascular system can catapult women into a metabolic syndrome that predisposes to atherosclerosis in later life. We sought to identify the nature of the epigenomic changes associated with the increased cardiovascular disease (CVD) risk in adult women following pre-eclampsia.FindingsWe assessed the genome wide epigenetic profile by methyl-C sequencing of monozygotic parous twin sister pairs discordant for a severe variant of pre-eclampsia. In the adult twin sisters at risk for CVD as a consequence of a complicated pregnancy, a set of 12 differentially methylated regions with at least 50% difference in methylation percentage and the same directional change was found to be shared between the affected twin sisters and significantly different compared to their unaffected monozygous sisters.ConclusionThe current epigenetic marker set will permit targeted analysis of differentially methylated regions potentially related to CVD risk in large cohorts of adult women following complicated pregnancies.

A Mobile Full-Time Daily System for Fetal Monitoring

The article describes a mobile hardware and software system designed for daily monitoring of the state of fetal and maternal cardiovascular systems. The assessment is carried out by means of recording and further online analysis of acoustic data, obtained from the abdominal surface of a pregnant woman’s body. The components and operating principles of the hardware and software system designed are described. The results of experimental studies aimed at assessing the applicability of a method of acoustic data analysis implemented in the system developed are shown. The results obtained have been compared with the results obtained using cardiotocography.

Long-Term Measurement of Maternal Pulse Rate Dynamics Using a Home-Based Sleep Monitoring System

Major adaptations occur in the maternal cardiovascular system during pregnancy and after delivery; knowledge of these changes is essential to the health management of pregnant women. This paper presents a longitudinal study and proposes a methodology to monitor daily pulse rates (PRs) and characterize the weekly changes in maternal PRs before and after delivery. PRs were recorded during nightly sleep using an automatic monitoring system. PRs of the nonpregnant woman were taken as a reference. Weekly PR properties were characterized by histogram and a two-Gaussian mixture model. A coupling use of sample entropy and pulse rate was applied to cluster the stages during recovery period after delivery. Results depicted a profile of individual’s cardiac recovery process in late pregnancy and after delivery. The results reveal that maternal PRs show different patterns in various stages of recovery. Later stages of recovery seemed to require a much longer period. The present study introduced a convenient approach in long-term maternal cardiac condition monitoring.

Cardiac magnetic resonance imaging to assess the impact of maternal habitus on cardiac remodeling during pregnancy

It is well known that the maternal cardiovascular system undergoes profound alterations throughout pregnancy. Interest in understanding these changes has led investigators to use evolving and increasingly sophisticated techniques to study these changes, most recently with 2-dimensional echocardiography. Despite its clinical utility, echocardiography has limitations, and cardiac magnetic resonance imaging (CMRI) has become increasingly used for evaluation of cardiac structure and function. We used CMRI to evaluate cardiac remodeling according to maternal habitus throughout pregnancy and postpartum. This was a prospective, observational study ofnulliparous women aged 18-30 years, without preexisting medical conditions, conducted from October 2012 through December 2014. Women were classified according to prepregnancy body mass index (BMI) as either normal (BMI 18.5-24.9 kg/m(2)) or overweight (BMI 25-35 kg/m(2)). All women underwent CMRI during 5 epochs throughout gestation: 12-16 weeks, 26-30 weeks, 32-36 weeks, at delivery, and 3 months' postpartum. Using left ventricular mass (LVM) as a marker of cardiac remodeling, the 2 cohorts were compared. There were 14 normal-weight (BMI 22.2 ± 1.3) and 9 overweight (BMI 29.1 ± 2.0) women who participated in the study. Beginning at 26-30 weeks and continuing to delivery, LVM of both normal-weight and overweight women was significantly increased compared with the respective first-trimester studies for each cohort (P < .001). LVM of both cohorts returned to their index values by 3 months' postpartum. The geometric ratio of LVM to left ventricular end-diastolic volume was calculated, and both normal-weight and overweight women demonstrated concentric remodeling throughout gestation, however this resolved by 12weeks' postpartum. There is substantial cardiac remodeling during pregnancy with significant increases in LVM that are proportional to maternal size. Left ventricular geometric remodeling was concentric in both normal-weight and overweight women. All changes in cardiac remodeling resolved by 3 months' postpartum.

Current Theories on the Prevention of Severe Preeclampsia With Low-Molecular Weight Heparin

During normal pregnancy, the maternal cardiovascular system undergoes important anatomic and functional modifications to establish a low-resistance, high-volume state to support fetal demands for nutrients and gas exchange.1 Cardiac output increases by as much as 30% to 40%, resulting from increases in stroke volume and, to a lesser extent, heart rate. Gestational hormones and alterations in the synthesis of, and reactivity to, vasoactive substances result in systemic vasodilatation.2 Despite increases in cardiac output, maternal blood pressure decreases because of a substantial reduction in systemic vascular resistance. Pregnancy is also associated with an increase in venous capacitance and a parallel large expansion of blood volume.3 The purpose of these maternal changes is to promote blood flow to the implantation site to optimize fetal growth, increase maternal renal excretory functions because of excess maternal, placental, and fetal metabolic demand, and to withstand hemorrhage at delivery. Hemodynamic and vascular adaptations that occur in normal pregnancy are disrupted in women who develop preeclampsia (PE), a hypertensive disorder that affects 2% to 8% of all pregnancies worldwide.4 PE is characterized by new-onset hypertension (blood pressure consistently >140/90 mm Hg) after 20 weeks of gestation, accompanied by evidence of organ injury (proteinuria, thrombocytopenia, renal or liver impairment, pulmonary edema, or cerebral/visual symptoms suggesting cerebral cortical dysfunction), as redefined by the American College of Obstetrics and Gynecology in 2013.5 PE can be subdivided into early-onset PE (before 34 weeks of gestation), the more severe subset of the disease with smaller birthweight neonates and a higher rate of recurrence, and late-onset PE (after 37 weeks of gestation).6 Once established, PE often advances until delivery and may persist for some time in the postpartum period.7–10 Recent population-based cohort studies have concluded that women with a history of PE are at …

P51. Screening for preeclampsia in the first trimester: A reduced fat mass increases the risk in normo BMI patients

Introduction Maternal cardiovascular system adapts to pregnancy thanks to complex physiological mechanisms that involve cardiac output, total vascular resistance (TVR) and water body distribution. Abnormalities of this adaptive mechanism are connected with hypertensive disorders and foetal growth restriction. Moreover, maternal serum PAPP-A is considered a biochemical marker extensively used for the first trimester screening of PE. Objective To identify patients at high risk of developing hypertensive complications of pregnancy during the first trimester through the use of non-invasive methods such as USCOM (Ultrasonic Cardiac Output Monitor), bioimpedance and biochemical marker. Materials and Methods We enrolled 96 healthy normotensive women with normal Body Mass Index during the first trimester of pregnancy (from 11+0 to 13+6weeks of gestation) obtaining all measurements with the USCOM system, Bioimpedance and collecting MoM values of PAPP-A Results Patients were divided into two groups: Group A ( n =54) with TVR n =42) with TVR >1200dynesseccm −5 . 10% ( n =10) of our study population developed pregnancy complications as IUGR and hypertensive disorders. In this group 81% of patients presented high TVR values and 37% PAPP-A p Conclusions High TVR and lower Fat Mass during the first weeks of gestation may be an early marker of cardiovascular maladaptation more than the evaluation of PAPP-A values and blood pressure assessment.

Role, risk and benefit of interventional cardiology procedures during pregnancy

Pregnancy is associated with significant hemodynamic, tissue and hematic changes in the maternal cardiovascular system, which could result in worsening some previously asymptomatic cardiac conditions. Since the last 30 years, new techniques and devices have been introduced in the field of structural and coronary heart disease. In this review, we describe the balance between the risk and benefit of percutaneous therapy and the possibility of transcatheter approach to the most common heart disease during pregnancy.

Assessment of total vascular resistance and total body water in normotensive women during the first trimester of pregnancy. A key for the prevention of preeclampsia

Maternal cardiovascular system adapts to pregnancy, thanks to complex physiological mechanisms that involve cardiac output, total vascular resistance and water body distribution. Abnormalities of these adaptive mechanisms are connected with hypertensive disorders. To identify patients at a high risk of developing hypertensive complications of pregnancy during the first trimester of pregnancy, through the use of non-invasive methods such as USCOM (Ultrasonic Cardiac Output Monitor) and Bioimpedance. We enrolled 120 healthy normotensive women during the first trimester of pregnancy obtaining all measurements with the USCOM system and Bioimpedance. 20 patients were excluded for a bad USCOM signal. The remaining patients (n = 100) were retrospectively divided into two groups: Group A (n = 75) TVR<1200 dynes s cm(-5), Group B (n = 25) TVR>1200 dynes s cm(-5). No statistically significant difference was identified in terms of water distribution, Fat Free Mass, Systolic/Diastolic Blood Pressure, Heart Rate, Hematocrit, Flow Time Corrected and Water Balance Index between the two groups. In contrast, higher values of the Cardiac Output, Stroke Volume, Fat Mass and Inotropy Index have been highlighted in the Group A. Moreover, in the Group A we found a better maternal-neonatal outcome and a lower incidence of hypertensive complications. High TVR during the first weeks of gestation may be an early marker of cardiovascular maladaptation more than the evaluation of water distribution and, in particular, with respect to the single blood pressure assessment. Moreover lower values of Inotropy Index could be an indicative of the worst cardiac performance.

Peripartum cardiomyopathy: current management and future perspectives.

Pregnancy is associated with marked physiological changes challenging the cardiovascular system. Among the more severe pregnancy associated cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. A major challenge is to distinguish the peripartum discomforts in healthy women (fatigue, shortness of breath, and oedema) from the pathological symptoms of PPCM. Moreover, pregnancy-related pathologies such as preeclampsia, myocarditis, or underlying genetic disease show overlapping symptoms with PPCM. Difficulties in diagnosis and the discrimination from other pathological conditions in pregnancy may explain why PPCM is still underestimated. Additionally, underlying pathophysiologies are poorly understood, biomarkers are scarce and treatment options in general limited. Experience in long-term prognosis and management including subsequent pregnancies is just beginning to emerge. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system by comparing normal conditions, hypertensive complications, genetic aspects, and infectious disease in PPCM-pregnancies. It also presents clinical and basic science data on the current state of knowledge on PPCM and brings them in context thereby highlighting promising new insights in diagnostic tools and therapeutic approaches and management.

Biaxial Creep Resistance and Structural Remodeling of the Aortic and Mitral Valves in Pregnancy

Pregnancy produces rapid, dramatic volume-overload changes to the maternal circulation. This paper examines pregnancy-induced structural-mechanical changes in bovine aortic and mitral heart valve leaflets. Valve leaflets were harvested from non-pregnant heifers and pregnant cows. Dimensions, biaxial extensibility and creep resistance were assessed and related to changes in the collagen network: histological leaflet and anatomic layer thicknesses plus collagen crimp, and biochemical collagen content. Collagen stability and crosslinking were assessed thermomechanically. Pregnancy altered both aortic and mitral valve leaflets. Both valves demonstrated biphasic changes in leaflet stretch, decreasing in early pregnancy and recovering by late pregnancy. Creep in leaflets from both valves was minimal and decreased even further with pregnancy in the mitral valve. There were valve-specific changes in preconditioning areal extension with pregnancy: increasing in the aortic valve and decreasing in the mitral valve. Leaflet area increased dramatically (84% aortic, 56% mitral), with thickening mainly in the fibrosa, accompanied by increases in collagen content (8% aortic, 16% mitral): together suggesting synthesis of new collagen. Collagen crimp was almost completely lost in pregnancy, with the denaturation temperature decreased by approximately 2 °C. Mature and total crosslinking increased, curiously without a significant increase in immature crosslinking. Mature aortic and mitral heart valve leaflets in the maternal cardiovascular system remodel substantially and similarly-despite their different embryological origins.

Preeclampsia - What is to blame? The placenta, maternal cardiovascular system or both?

Preeclampsia - What is to blame? The placenta, maternal cardiovascular system or both?

Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort.

BackgroundThe maternal cardiovascular system undergoes progressive adaptations throughout pregnancy, causing blood pressure fluctuations. However, no consensus has been established on its normal variation in uncomplicated pregnancies.ObjectiveTo describe the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels during pregnancy according to early pregnancy body mass index (BMI).MethodsSBP and DBP were measured during the first, second and third trimesters and at 30-45 days postpartum in a prospective cohort of 189 women aged 20-40 years. BMI (kg/m2) was measured up to the 13th gestational week and classified as normal-weight (<25.0) or excessive weight (≥25.0). Longitudinal linear mixed-effects models were used for statistical analysis.ResultsA decrease in SBP and DBP was observed from the first to the second trimester (βSBP=-0.394; 95%CI: -0.600- -0.188 and βDBP=-0.617; 95%CI: -0.780- -0.454), as was an increase in SBP and DBP up to 30-45 postpartum days (βSBP=0.010; 95%CI: 0.006-0.014 and βDBP=0.015; 95%CI: 0.012-0.018). Women with excessive weight at early pregnancy showed higher mean SBP in all gestational trimesters, and higher mean DBP in the first and third trimesters. Excessive early pregnancy BMI was positively associated with prospective changes in SBP (βSBP=7.055; 95%CI: 4.499-9.610) and in DBP (βDBP=3.201; 95%CI: 1.136-5.266).ConclusionSBP and DBP decreased from the first to the second trimester and then increased up to the postpartum period. Women with excessive early pregnancy BMI had higher SBP and DBP than their normal-weight counterparts throughout pregnancy, but not in the postpartum period.

Pregnancy-associated cardiomyopathies

Summary Cardiovascular disease is a major cause of complications in pregnancy worldwide and the number of patients who develop cardiac problems during pregnancy is increasing. The physiological changes occurring during pregnancy and in the peripartum period provide a challenge to the cardiovascular system of all women. Understanding the morphological and functional changes in normal pregnancy is therefore important for the timely recognition of cardiovascular pathology during this vulnerable period. However, evidence-based clinical data in this field are scarce and there is a deficit in understanding general physiological and pathophysiological processes operating in the maternal heart around pregnancy. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system with a special focus laid on hypertensive complications in pregnancy, i.e., pre-eclampsia. A second focus is set on peripartum heart failure, especially peripartum cardiomyopathy (PPCM) which is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. We present clinical and basic science data on the current state of knowledge of normal pregnancy, pre-eclampsia and PPCM and bring them into context thereby highlighting promising novel diagnostic tools and therapeutic approaches.

The Pulse Wave Analysis of Normal Pregnancy: Investigating the Gestational Effects on Photoplethysmographic Signals

Normal pregnancy is associated with profound alterations in the maternal cardiovascular system and PPG represents a sensitive and convenient technique capable of tracking changes in the pulsatile function of arteries. The aim of this study was to investigate the effects of maternal cardiovascular alterations on the finger tip photoplethysmography (PPG) during normal gestation. Thirty five healthy pregnant women were studied at each trimester of pregnancy and again on gestational age using PPG signals, peripheral blood pressure (BP) and heart rate (HR). Comparing with nonpregnant controls, several characteristic differences in PPG derived parameters and morphologies occurred in the pregnant. PAI, RI, PTT as well as AUC1 and Y1 of bcAUC1 were different and significant difference had been found in second and third trimester, despite little change in the peripheral blood pressure. The mean heart rate increased linearly with gestational age. This study has confirmed that normal pregnancy is associated with profound alterations in PPG signals occurred principally as a result of maternal cardiovascular adaptation and PPG-based noninvasive assessment of cardiovascular activities is feasible throughout pregnancy. Using this technique we demonstrated a delay in wave reflection within the arterial tree and a reduction in magnitude of arterial wave reflections in normal pregnancy which is consistent with previous observations and the known cardiovascular changes of pregnancy.

Response to Assessment of Retinal Vasculature in Pregnancy: Unveiling the Complex Pathogenesis of Gestational Vascular Complications

We thank Triantafyllou et al for the insightful questions they have raised about our article. Through adjusting the central retinal arteriolar equivalent and the central retinal venular equivalent for blood pressure (BP), we provide a single measurement with which to compare changes in the maternal peripheral cardiovascular system, particularly peripheral resistance. Because the diameter of an arteriole or venule is directly related to the pressure within the vessel, adjusting vessel diameter for BP generates data on peripheral resistance, which is easily comparable between individuals, groups, and in the same individual at different time points. We hypothesize …

Cardiovascular variability before and after delivery: recovery from arterial stiffness in women with preeclampsia 4 days post partum

Objective: We studied the short-term response of autonomic control to delivery in normal pregnancies and pregnancies with preeclampsia (PE). Methods: Fourteen healthy pregnant women and 13 women with PE were monitored within four days before and four days after delivery and compared to values of 14 non-pregnant women as controls using high-resolution electrocardiogram and noninvasive continuous blood pressure monitoring. Results: In PE, blood pressure remained elevated four days postpartum, but markers for arterial stiffness normalized. In contrast, none of heart rate variability and baroreflex sensitivity parameters, altered due to either pregnancy or disease, were normalized 96 h after delivery. Conclusion: Four days after delivery, the maternal cardiovascular system is still strongly affected by pregnancy independent of the health status.

MATERNAL CARDIAC TWIST PRE-PREGNANCY: POTENTIAL AS A NOVEL MARKER OF PRE-ECLAMPSIA

Healthy pregnancy is characterised by progressive physiological adaptation of the maternal cardiovascular (CV) system that facilitates optimal fetal development. The adaptations that constitute a healthy or normal progression are not always evident, and, in particular, CV adaptation to pregnancy is highly individualised. Some women develop pregnancy-related CV dysfunction such as pre-eclampsia (PE). Typically, PE is diagnosed by the development of hypertension and proteinuria after 20 weeks of pregnancy and is the leading cause of maternal and perinatal mortality and morbidity. Despite continued efforts to improve the understanding of the aetiology, pathophysiology and subsequently treatment for the disease, CV changes in PE are not well understood. PE before 34 weeks (early onset PE) is believed to differ in pathogenesis from late onset PE (&gt;34 weeks) and can be characterised by a haemodynamic profile of increased systemic vascular resistance (SVR) and lower cardiac output (CO). Early onset PE is more often associated with uteroplacental insufficiency and significant adverse maternal and perinatal outcomes. In contrast, late onset PE (&gt;34 weeks) involves an increased CO and lower SVR and is less likely to be associated with uteroplacental insufficiency and adverse perinatal outcomes. It is not known if PE develops secondary to the CV maladaptation in pregnancy or if a preexisting CV dysfunction predisposes some women to develop PE. Screening, diagnosis and disease management would be vastly improved if more were known about the onset of the maladaptive process associated with PE. To date, a combination of maternal factors including medical history, body mass index, age, parity and blood pressure (BP) have been used to predict the development of PE. In the first trimester, arterial stiffness is significantly increased in women who develop PE. Current hypotheses speculate that CV dysfunction is evident very early in pregnancy in PE and precedes the clinical manifestation at a later stage but whether CV dysfunction is present before pregnancy remains to be elucidated.

English

Anemia in female during pregnancy is very common, it affect maternal blood leading to maternal hypoxia. Anemia also exerts profound changes on the maternal circulatory system and has serious effects both on mother and fetus. Growth of fetus is intricately linked with that of placenta, because placenta causes transfer of nutrients as well as oxygen from mother to fetus. So chances of Low birth weight baby and premature delivery increases. Hypoxia cause morphological changes in placenta like increased weight, diameter & thickening of placentas. Placenta is a focus of increasing interest in modern obstetrics because significant pathology afflicts the placenta, often before affecting the fetus. Placental abnormalities therefore can be an 'early warning system' for fetal problems. The evaluation of placenta thus becomes essential in high risk pregnancy. As most of the perinatal fetal deaths, were related to the insufficient oxygen supply in utero, placenta plays a pivotal role in the transport of oxygen to the fetus. , it remains major path finder for the ultimate goal of healthy fetal outcome. Therefore study of placenta is a valuable tool in predicting the outcome of future pregnancies and their management.