Hypertensive Disorder of Pregnancy, Intrauterine Growth Restriction, Pulmonary Arterial Hypertension
Conditions
Brief summary
In this study, the investigators will follow two small cohorts of pregnant women: a cohort of healthy women with uncomplicated pregnancies residing at high altitude, a control group of healthy women with uncomplicated pregnancies residing at sea level, to characterize differences in cardiopulmonary adaptation and nitric oxide (NO) pathway expression at elevations \>3,500 m throughout pregnancy and into the postpartum period. The investigators aim to investigate right-sided cardiac impairment induced by chronic hypobaric hypoxemia, its effects on fetal growth, and the potential contribution of cardiovascular nitric oxide depletion to obstetric complications.
Detailed description
To investigate cardiac impairment, the investigators will perform transthoracic echocardiography in all enrolled pregnant women and infants, with a focus on right-sided cardiac anatomy and function, including pulmonary artery pressures, right ventricular thickness, right ventricular systolic performance, and indices of pulmonary vascular load. To investigate the effects of hypobaric hypoxia on fetal growth, the investigators will measure intrauterine and post-delivery growth parameters, assess placental weight and histologic features, and correlate these findings with maternal oxygenation status and altitude exposure. To assess nitric oxide production and consumption, the investigators will quantify nitric oxide-related metabolites (NO metabolomics) in maternal blood, umbilical cord blood, and placental tissue in both cohorts, and correlate these biomarkers with pulmonary arterial pressures, and right ventricular function. The investigators will also assess flow-mediated dilation in the high altitude cohort and relate these measures of endothelial function to pulmonary vascular and obstetric outcomes.
Interventions
None listed
Sponsors
Massachusetts General Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
* women delivering at participating hospitals at more than 3500 meters or women delivering at participating hospitals at sea level * signed informed consent
Exclusion criteria
* preexisting cardiopulmonary pathologies (CHD, COPD, CKD, NYHA \> III)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pulmonary artery pressures | Late pregnancy (35 ± 4 weeks gestation) and postpartum (6 ± 0.3 weeks) | Measurement will be performed by transthoracic echocardiography. |
| Echographic estimate of fetal weight | Late pregnancy (35 ± 4 weeks gestation) | — |
| Nitric oxide metabolites | Late pregnancy (35 ± 4 weeks gestation) and postpartum (6 ± 0.3 weeks) for maternal samples, at delivery (neonatal samples) | Measurement will be performed with a chemiluminescence assay. |
| RV remodeling echocardiography parameters | Late pregnancy (35 ± 4 weeks gestation) and postpartum (6 ± 0.3 weeks) | — |
| Weight at birth | At delivery | — |
Countries
Bolivia, United States
Contacts
CONTACTLorenzo Berra, MD
CONTACTAndrea Bolchini, MD
PRINCIPAL_INVESTIGATORLorenzo Berra, MD
Massachusetts General Hospital
Outcome results
None listed