Women who develop high blood pressure during pregnancy are at substantial risk of future cardiovascular disorders, which emerge earlier in life than for women who have pregnancies without high blood pressure or complications related to this. Of particular concern, recent evidence highlights that high blood pressure during pregnancy doubles the risk of hospitalisation for heart failure, specifically, heart failure with preserved ejection fraction (HFpEF). Once established, changes in the heart underlying HFpEF are difficult to modify and prevention is considered a priority. However, we, and others, have shown changes in the heart consistent with early HFpEF are already evident following a pregnancy complicated by high blood pressure, before significant exposure to other known risk factors for HFpEF such as long-standing hypertension and diabetes.
Therefore, to understand whether there is a clinical rationale for pregnancy-related interventions to prevent later HFpEF we propose, firstly, to follow up the original maternal G0 cohort from the Avon Longitudinal Study of Parents and Children to determine whether high blood pressure during pregnancy remains independently associated with the presence of sub-clinical and clinical HFpEF in later life. Secondly, we will use cardiovascular magnetic resonance and echocardiography imaging techniques to characterise the changes and clinical features observed in the heart in this group. Finally, we will identify key biomarkers in the heart that are clinically relevant to the phenotype of HFpEF associated with high blood pressure during pregnancy. We will then study these biomarkers in other trials we currently have in progress that are using interventions earlier in life to try and prevent disease.
An additional anticipated feature of this project is the synergistic opportunity to link the imaging data we will collect in the maternal cohort of ALSPAC with our ongoing CLARITY study that is undertaking similar imaging of the ALSPAC G1 cohort of adults born to these pregnancies. We hope to link the imaging findings from the mothers and their children between cohorts to determine whether they share distinct familial patterns of cardiac remodelling.