Maternal Vascular Lesions in the Placenta Predict Vascular Impairments a Decade After Delivery

Author:

Catov Janet M.12ORCID,Muldoon Matthew F.3ORCID,Gandley Robin E.1,Brands Judith1,Hauspurg Alisse1,Hubel Carl A.1,Tuft Marie4,Schmella Mandy5ORCID,Tang Gong4ORCID,Parks W. Tony6

Affiliation:

1. Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, School of Medicine, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh PA (J.M.C., R.E.G., J.B., A.H., C.A.H.).

2. Department of Epidemiology, Graduate School of Public Health (J.M.C.), University of Pittsburgh, PA.

3. Cardiology Division, Department of Medicine, University of Pittsburgh School of Medicine, PA (M.F.M.).

4. Graduate School of Public Health (M.T., G.T.), University of Pittsburgh, PA.

5. School of Nursing (M.S.), University of Pittsburgh, PA.

6. Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada (W.T.P.).

Abstract

Women with adverse pregnancy outcomes later experience excess hypertension and cardiovascular disease, but how the events are linked is unknown. Examination of the placenta may provide clues to vascular impairments after delivery. Maternal vascular malperfusion lesions (MVMs) were abstracted from clinical reports, validated and characterized using clinical guidelines and severity score. A total of 492 women (170 with MVMs and 322 without MVMs) participated in a study visit 8 to 10 years after delivery to assess blood pressure, cardiometabolic factors, and sublingual microvascular features using sidestream dark field imaging. Covariates included age, race, adverse pregnancy outcomes (preeclampsia, small for gestational age, and preterm birth), and health behaviors. Women with versus without MVM had a distinct sublingual microvascular profile comprised of (1) lower microvascular density (−410 μm/mm 2 , P =0.015), (2) higher red blood cell filling as a marker of perfusion (2%, P =0.004), and (3) smaller perfused boundary region (−0.07 µm, P =0.025) as a measure of glycocalyx integrity, adjusted for covariates including adverse pregnancy outcomes. Women with MVM also had higher adjusted diastolic blood pressure (+2.6 mm Hg, P =0.021), total and LDL (low-density lipoprotein)-cholesterol (+11.2 mg/dL, P =0.016; +8.7 mg/dL, P =0.031). MVM associations with subsequent cardiovascular measures did not vary by type of adverse pregnancy outcome, except among women with preterm births where blood pressure was higher only among those with MVM. Results were similar when evaluated as MVM severity. A decade after delivery, women with placental vascular lesions had an adverse cardiovascular profile comprised of microvascular rarefaction, higher blood pressure and more atherogenic lipids. Placental histopathology may reveal a woman’s early trajectory toward subsequent vascular disease.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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