Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway.
Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
Pregnancy Hypertens. 2022 Dec;30:103-109. doi: 10.1016/j.preghy.2022.09.003. Epub 2022 Sep 16.
Cardiovascular disease (CVD) is the leading cause of death in women, yet sex-specific risk factors remain understudied. Preeclampsia and other adverse pregnancy outcomes imply an increased maternal cardiovascular risk. We hypothesized that cardiac troponin T (cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) are increased in such pregnancies and correlate with markers of placental dysfunction. We also investigated these cardiovascular biomarkers 1 or 3 years postpartum. Prior to delivery, we included serum from 417 pregnant women: 55 early-onset preeclampsia (EO-PE), 63 late-onset preeclampsia (LO-PE), 30 gestational hypertension (GH) and 269 healthy controls. Postpartum, we included 341 women 1 or 3 years after delivery: 26 EO-PE, 107 LO-PE, 61 GH, and 147 healthy pregnancies. Prior to delivery, median cTnT and NT-proBNP concentrations were higher in women with EO-PE, LO-PE, or GH than in controls. Median GDF-15 was higher in EO-PE and LO-PE compared to controls. Postpartum, GDF-15 was elevated in women with previous EO-PE. Markers of placental dysfunction correlated with CVD biomarkers in pregnancy, but not postpartum. Our findings underscore the cardiovascular burden of hypertensive disorders of pregnancy and the crosstalk with placental function. The upregulation of circulating GDF-15 following early-onset preeclampsia is in line with the epidemiological excessive risk of premature CVD in this group of women. GDF-15 may be explored for targeting postpartum women with most to gain from intensified preventive follow-up for CVD.
心血管疾病（CVD）是女性死亡的主要原因，但性别特异性危险因素仍研究不足。子痫前期和其他不良妊娠结局意味着母体心血管风险增加。我们假设心脏肌钙蛋白 T（cTnT）、N 端脑利钠肽前体（NT-proBNP）和生长分化因子 15（GDF-15）在这些妊娠中增加，并与胎盘功能障碍的标志物相关。我们还在产后 1 或 3 年调查了这些心血管生物标志物。在分娩前，我们纳入了 417 名孕妇的血清：55 名早发型子痫前期（EO-PE）、63 名晚发型子痫前期（LO-PE）、30 名妊娠高血压（GH）和 269 名健康对照组。产后，我们纳入了 341 名产后 1 或 3 年的女性：26 名 EO-PE、107 名 LO-PE、61 名 GH 和 147 名健康妊娠。在分娩前，EO-PE、LO-PE 或 GH 妇女的 cTnT 和 NT-proBNP 浓度中位数高于对照组。EO-PE 和 LO-PE 的 GDF-15 中位数高于对照组。产后，既往 EO-PE 的女性 GDF-15 升高。胎盘功能障碍的标志物与妊娠期间的 CVD 生物标志物相关，但与产后无关。我们的研究结果强调了妊娠高血压疾病的心血管负担以及与胎盘功能的相互作用。早发型子痫前期后循环 GDF-15 的上调与该组女性过早发生 CVD 的流行病学高风险一致。GDF-15 可能被探索用于针对最需要强化 CVD 预防随访的产后女性。
