AIMS

* To investigate the associations between exposure to HDP and blood pressure trajectories during pregnancy with offspring cardiac structure and function.

HYPOTHESIS

We hypothesize that the cardiac function and left ventricular geometry in adolescents exposed to HDP is less favorable compared to offspring of normotensive mothers.

METHODS

We will use data from ALSPAC to investigate the association between preeclampsia and offspring cardiac structure and function. Of the 5,217 adolescent children investigated, 2,000 conceded to echocardiography.

The echocardiograph examination

Echocardiography was performed using a HDI 5000 ultrasound machine (Phillips) equipped with a P4-2 Phased Array ultrasound transducer using a standard examination protocol. All measurements were made according to American Society of Echocardiography (ASE) guidelines.

Definition of exposure variables

* Being born to a mother with preeclampsia or GH.

* Blood pressure trajectories during pregnancy

Confounding/mediating variables (available data)

Sex of offspring, birth weight, length of pregnancy, the adolescent's own blood pressure, maternal pre pregnancy blood pressure, maternal pre pregnancy BMI, maternal and offspring smoking and physical activity, age and parity of mother, height in adolescence, weight/fat mass in adolescence, occupational social class, maternal diabetes in pregnancy.

Outcome variables

Cardiac structure

* Left ventricular size indexed to height (LVMI)

* Left ventricular geometry (based on LVMI and left ventricular relative wall thickness)

Cardiac function

* Left ventricular systolic function (Ejection fraction etc.)

* Left ventricular diastolic function (E/A, E'/A')

Statistical analyses

All statistical modeling will be made in SAS (SAS Institute inc., Cary, NC, USA). We will use multivariate linear models to estimate the associations and adjust for potential confounders and mediators. A previous study based on the follow-up clinic at 17 years reported the prevalence of exposure to preeclampsia and GH in utero to be 2% and 15%, respectively.5 Assuming a similar prevalence in the subgroup examined by echocardiography, this would result in 40 study participants having been exposed to preeclampsia and 300 having been exposed to GH.