Evsevieva Maria, Sergeeva Oksana, Mazurakova Alena, Koklesova Lenka, Prokhorenko-Kolomoytseva Irina, Shchetinin Evgenij, Birkenbihl Colin, Costigliola Vincenzo, Kubatka Peter, Golubnitschaja Olga
Stavropol State Medical University, Stavropol, Russian Federation.
Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia.
EPMA J. 2022 Aug 17;13(3):351-366. doi: 10.1007/s13167-022-00294-1. eCollection 2022 Sep.
Cardiovascular disease remains the leading cause of disease burden globally with far-reaching consequences including enormous socio-economic burden to healthcare and society at large. Cardiovascular health is decisive for reproductive function, healthy pregnancy and postpartum. During pregnancy, maternal cardiovascular system is exposed to highly increased haemodynamic stress that significantly impacts health status of the mother and offspring. Resulting from sub-optimal maternal health conditions overlooked in pre-pregnancy time, progressive abnormalities can be expected during pregnancy and postpartum. Contextually, there are two main concepts to follow in the framework of predictive, preventive and personalised medicine, namely to develop:1. advanced screening of sub-optimal health conditions in young populations to predict and prevent individual health risks prior to planned pregnancies2. in-depth companion diagnostics during pregnancy to predict and prevent long-lasting postpartum health risks of the mother and offspring.Data collected in the current study demonstrate group-specific complications to health of the mother and offspring and clinical relevance of the related phenotyping in pre-pregnant mothers. Diagnostic approach proposed in this study revealed its great clinical utility demonstrating important synergies between cardiovascular maladaptation and connective tissue dysfunction. Co-diagnosed pre-pregnancy low BMI of the mother, connective tissue dysfunction, increased stiffness of peripheral vessels and decreased blood pressure are considered a highly specific maternal phenotype useful for innovative screening programmes in young populations to predict and prevent severe risks to health of the mother and offspring. This crucial discovery brings together systemic effects characteristic, for example, for individuals with Flammer syndrome predisposed to the phenotype-specific primary vascular dysregulation, pregnancy-associated risks, normal tension glaucoma, ischemic stroke at young age, impaired wound healing and associated disorders. Proposed maternal phenotyping is crucial to predict and effectively protect both the mother and offspring against health-to-disease transition. Pre-pregnancy check-up focused on sub-optimal health and utilising here described phenotypes is pivotal for advanced health policy.
Cardiovascular health is decisive for reproductive function and healthy pregnancy. During pregnancy, maternal cardiovascular system may demonstrate health-to-disease transition relevant for the affected mother and offspring. Overlooked in pre-pregnancy time, progressive abnormalities can be expected during pregnancy and lifelong. Here we co-diagnosed maternal pre-pregnancy low bodyweight with systemic effects which may increase risks of pregnancy, eye and heart disorders and ischemic stroke at young age, amongst others. Innovative screening programmes focused on sub-optimal health in young populations to predict and to mitigate individual health risks prior to pregnancy is an essential innovation for health policy proposed.
心血管疾病仍然是全球疾病负担的主要原因，其影响深远，包括给医疗保健和整个社会带来巨大的社会经济负担。心血管健康对生殖功能、健康怀孕及产后状况起着决定性作用。在孕期，母体心血管系统会承受大幅增加的血流动力学压力，这对母亲和后代的健康状况有重大影响。由于孕前未被重视的母体健康状况欠佳，孕期及产后可能会出现渐进性异常。在此背景下，在预测、预防和个性化医疗框架中有两个主要理念需要遵循，即开展：1. 对年轻人群的健康欠佳状况进行高级筛查，以在计划怀孕前预测和预防个体健康风险；2. 在孕期进行深入的伴随诊断，以预测和预防母亲及后代长期的产后健康风险。本研究收集的数据显示了母亲和后代健康方面特定群体的并发症，以及孕前母亲相关表型分析的临床相关性。本研究提出的诊断方法显示出其巨大的临床实用性，表明心血管适应不良与结缔组织功能障碍之间存在重要协同作用。母亲孕前低体重指数、结缔组织功能障碍、外周血管僵硬度增加和血压降低等共同诊断结果被认为是一种高度特异性的母体表型，有助于在年轻人群中开展创新筛查项目，以预测和预防母亲及后代的严重健康风险。这一关键发现汇集了一些系统性效应特征，例如，对于具有Flammer综合征倾向于特定表型原发性血管调节异常、妊娠相关风险、正常眼压性青光眼、年轻时缺血性中风、伤口愈合受损及相关疾病的个体。所提出的母体表型分析对于预测并有效保护母亲和后代避免从健康向疾病转变至关重要。专注于健康欠佳状况并利用此处所述表型的孕前检查对于完善健康政策至关重要。
心血管健康对生殖功能和健康怀孕起着决定性作用。在孕期，母体心血管系统可能会出现与受影响的母亲和后代相关的从健康到疾病的转变。由于孕前未被重视，孕期及一生都可能出现渐进性异常。在此，我们共同诊断出母体孕前低体重伴有系统性影响，这可能会增加妊娠、眼部和心脏疾病以及年轻时缺血性中风等风险。针对年轻人群健康欠佳状况开展创新筛查项目，以在怀孕前预测和减轻个体健康风险，是所提出的健康政策的一项重要创新。
