Cardiac Connection: New study reveals association of Pre-eclampsia and Fetal Heart Defects

The pathophysiology of pre-eclampsia has traditionally been thought to result from placental dysfunction; however, a heart-related origin has been proposed recently. While a link between fetal congenital heart disease and pre-eclampsia has been established, a specific biological mechanism explaining this association remains undefined. Recent research paper explores the potential cardiac origin and pathophysiological mechanisms underlying the association between fetal congenital cardiovascular disease and pre-eclampsia. While the dominant theory has been that pre-eclampsia stems from placental dysfunction, a cardiac origin has been more recently proposed.

Biophysical and Biochemical Markers

The paper highlights various biophysical and biochemical markers of cardiac dysfunction that have been investigated as potential predictors of pre-eclampsia. Biophysical markers include echocardiography and Doppler indices, which have shown that women with pre-eclampsia demonstrate evidence of cardiac dysfunction, such as increased left ventricular wall mass and deteriorating diastolic indices. Biochemical markers include proteomic, metabolomic and genetic/transcriptomic markers.

Proteomic and Metabolomic Studies

Proteomic markers like NT-proBNP, troponins, and other proteins involved in inflammation and angiogenesis have been investigated. Metabolomic studies have found elevated levels of lipids, fatty acids, acylcarnitines, and amino acids like glutamate, which are associated with increased cardiac disease risk. Transcriptomic and epigenetic analysis has revealed shared pathways involving oxidative stress, inflammation, and immune responses between cardiovascular disease and pre-eclampsia. The paper also discusses the link between fetal congenital heart disease and maternal pre-eclampsia. Fetuses with structural heart defects like ventricular septal defects, atrioventricular septal defects, and coarctation of the aorta have a higher risk of developing pre-eclampsia. Fetal biomarkers like natriuretic peptides have been explored as predictors of fetal cardiac dysfunction and its impact on the mother.

Conclusion

In summary, this research highlights the growing evidence supporting a cardiac origin for pre-eclampsia, in contrast to the traditional placental dysfunction theory. The shared pathophysiological pathways between maternal/fetal cardiac disease and pre-eclampsia, involving inflammation, oxidative stress, and angiogenic imbalance, provide a strong rationale for further investigating the cardiac basis of this pregnancy-specific condition.

Key Points

1. The paper explores the potential cardiac origin and pathophysiological mechanisms underlying the association between fetal congenital cardiovascular disease and pre-eclampsia, in contrast to the traditional placental dysfunction theory.

2. The paper highlights various biophysical markers of cardiac dysfunction, such as echocardiography and Doppler indices, which have shown that women with pre-eclampsia demonstrate evidence of cardiac dysfunction, including increased left ventricular wall mass and deteriorating diastolic indices.

3. Proteomic markers like NT-proBNP, troponins, and other proteins involved in inflammation and angiogenesis have been investigated as potential predictors of pre-eclampsia. Metabolomic studies have found elevated levels of lipids, fatty acids, acylcarnitines, and amino acids like glutamate, which are associated with increased cardiac disease risk.

4. Transcriptomic and epigenetic analysis has revealed shared pathways involving oxidative stress, inflammation, and immune responses between cardiovascular disease and pre-eclampsia.

5. Fetuses with structural heart defects like ventricular septal defects, atrioventricular septal defects, and coarctation of the aorta have a higher risk of developing pre-eclampsia, and fetal biomarkers like natriuretic peptides have been explored as predictors of fetal cardiac dysfunction and its impact on the mother.

6. The growing evidence supports a cardiac origin for pre-eclampsia, in contrast to the traditional placental dysfunction theory, and the shared pathophysiological pathways between maternal/fetal cardiac disease and pre-eclampsia provide a strong rationale for further investigating the cardiac basis of this pregnancy-specific condition.

Reference -

Kelly M Reilly et al. (2024). Feto-Maternal Indicators Of Cardiac Dysfunction As A Justification For The Cardiac Origins For Pre-Eclampsia.. *International Journal Of Gynaecology And Obstetrics: The Official Organ Of The International Federation Of Gynaecology And Obstetrics*. https://doi.org/10.1002/ijgo.15770.