Pregnancy-related risk factors for cardiovascular disease: Foetal and maternal cardiovascular function during and after normal and complicated pregnancies in relation to the dysfunctional placenta

BACKGROUND: Placental function influences the health of woman and foetus during pregnancy, and lifelong cardiovascular risk of both. Little is known of the mechanisms behind placental dysfunction and its cardiovascular effects. Further, cardiovascular malformation may in itself impact foetal development.

AIM: This translational project aims to clarify mechanisms and pathophysiology of placental dysfunction and its impact on foetal and maternal cardiovascular function including cardiac malformation and long-term effects on cardiovascular evolution during adolescence. We therefore evaluate serious pregnancy complications related to placental dysfunction, namely preeclampsia and intrauterine growth restriction in order to understand their parts in the aetiology and mechanisms underlying congenital and long-term cardiovascular effects.

PLAN: Healthy pregnant volunteers are included through antenatal services and pregnant patients by collaborators in obstetrics and foetal cardiology. Histology and magnetic resonance (MR) imaging are used to investigate the placenta. Blood is sampled for substances damaging the endothelium.

MR imaging is used to assess cardiovascular function of the mother-to-be and foetus during pregnancy, and of the mother’s heart the first year post partum. Cardiovascular and renal MR are performed in growth-restricted adolescents (included 15-years ago) together with 24-hour blood pressure and urine and blood samples. This is the only study in Sweden applying the suggested new foetal cardiovascular MR techniques.

The techniques were autumn 2017 introduced clinically for improved diagnosis of foetal cardiac malformation with direct impact on delivery planning.

SIGNIFICANCE: Early diagnosis and individualised treatment of preeclampsia will impact millions of women and children. Improved detection of needed preventive health care in adolescents after intrauterine growth restriction is imperative for delaying or avoiding future cardiovascular disease related to growth restriction. Improved diagnosis of foetal cardiac malformation leads to a sense of security for the parents-to-be and has direct impact on delivery planning.

Health care costs are approximately 4.5 billion USD/year. Thus, clarified mechanisms of placental dysfunction and its impact on the cardiovascular system and improved diagnosis of foetal cardiac malformation would have tremendous impact on women’s and children’s cardiovascular health, quality of life and on health economy.