Maternal and Offspring Cardiovascular Function following Pregnancy with Hypertensive Disorder

Abstract

Background: Hypertensive disorders of pregnancy (HDP) have been associated with increased cardiovascular risk for the mother and her offspring. However, it remains unknown whether cardiovascular changes are present in the postpartum period.

Methods: This was a cross-sectional study of women with singleton pregnancies. We recruited 33 women (20 following preeclampsia and 13 following gestational hypertension) and an equal number of women with uncomplicated pregnancy. Conventional and more advanced echocardiographic modalities such as speckle tracking were used to assess maternal and offspring cardiac function at 3-9 months postpartum.

Results: In women with HDP compared to those without, there was higher mean arterial pressure (mean 92.3 (SD 7.3) vs. 86.8 (8.3) mmHg, p = 0.007), left-ventricular mass indexed for body-surface area (64.5 (10.5) vs. 56.8 (10.03), p < 0.003), and E/e' (3.6 (0.8) vs. 3.1 (0.9), p = 0.022). There were no significant differences between groups in maternal left-ventricular systolic-functional indices and in offspring cardiac function between groups.

Conclusions: At 3-9 months postpartum, mothers with HDP had higher blood pressure, higher left-ventricular mass, and reduced left-ventricular diastolic function. However, in their offspring, cardiac function was preserved. These findings suggest that mothers who experienced an HDP would benefit from cardio-obstetric follow-up in the postpartum period.

Keywords: cardiac function; gestational hypertension; maternal; offspring; postpartum; preeclampsia.

Figure 1

Illustration of the measurement of longitudinal systolic strain in the 4-chamber view of the heart. Global longitudinal strain is calculated automatically by having measurements also in the 2-chamber and 3-chamber view. Abbreviations: AS: anteroseptal, MS: mid-septal, BS: basal septal, AL: anterolateral, ML: mid-lateral, BL: basal lateral [18]. LA: left atrium, LV: left ventricle, EDV: end diastolic volume, ESV: end systolic volume, EF: ejection fraction.

Figure 2

Illustration of tissue-Doppler imaging in the apical 4-chamber view. Analysis was performed for the peak systolic annular velocity (S), early mitral-annulus diastolic velocity (E′), and late diastolic velocity (A′). Timing intervals, isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), and ejection time (ET) were calculated as shown.