Having a low birthweight baby may increase risk for early heart failure

March 18, 2020

It's normal for expectant parents to worry about how well their baby is developing and growing. But could a newborn's birthweight serve as a red flag for risks to mom's future health, too? A new study, presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC), suggests that giving birth to a baby under 5.5 pounds may be an independent risk factor for developing changes in heart function that can lead to heart failure, a condition in which the heart is unable to pump enough blood and oxygen to meet the body's needs.

Recent data suggest adverse pregnancy outcomes, such as preeclampsia, high blood pressure during pregnancy, pre-term birth (<37 weeks) and low birth rate, are on the rise. In fact, 1 out of every 3 women in this study reported one of these issues. Echocardiograms--a test showing pictures of the heart and how well it is pumping--in these women were more likely to show abnormal changes in the heart compared with women who did not experience complications. These changes often represent early signs of heart failure risk.

Researchers said their findings are the first to examine early changes in heart function prior to a woman developing symptomatic heart failure and should raise concerns about the cardiovascular impact of adverse pregnancy complications.

"There is emerging evidence that what happens during pregnancy may be a window into a woman's future cardiovascular health, but there are still important knowledge gaps about the early trajectory following pregnancy complications and structural changes that happen before someone has an event, which may ultimately help us to identify targets for prevention," said Priya Mehta, MD, a cardiology fellow at Northwestern University in Chicago and the study's lead author. "At 30 years of follow up, the women who had an adverse pregnancy outcome in our study had a lower absolute global longitudinal strain on their echocardiograms, which is an early marker of increased risk for heart failure. Clearly, the risk for heart disease doesn't go away when pregnancy ends, and these complications are a critical piece of a woman's past medical history that is not always routinely reported or asked about."

The study included 936 women from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a national, longitudinal cohort study that has followed people from a young age to examine the development of, and risk factors for, cardiovascular disease. Mehta said that, unlike previous studies that focused on a first or specific pregnancy, their study included women who had been followed for three decades after recruitment in 1985-86 and, therefore, was able to capture the woman's entire reproductive life course. Participants were 24 years old, on average, at the start of the study, and about half were black. Women who already had diabetes, high blood pressure or heart failure were excluded. Researchers collected and analyzed the number of pregnancies, pregnancy complications (preeclampsia,

gestational hypertension, pre-term birth of <37 weeks gestation and birthweight <5.5 pounds), cardiovascular risk factors and findings on their echocardiogram at a 30-year follow-up. Mehta and the team looked specifically at changes in global longitudinal strain, which is a well-validated marker of the heart not pumping well and can predispose someone to heart failure.

Of the women in the study, 330 (35%) reported at least one adverse pregnancy outcome over an average of two births during the study period. At their 30-year follow-up, women who had experienced an adverse pregnancy outcome had a nearly 1% lower (worse) absolute global longitudinal strain--a magnitude of difference that has been shown in other studies to be associated with an increased risk for incident heart failure.

After adjusting for other known risk factors for heart disease, only low birthweight remained significantly associated with echocardiogram changes suggestive of increased risk for heart failure. For women with hypertensive disorders of pregnancy (preeclampsia or gestational hypertension) or pre-term birth, the risk for heart failure seemed to be explained, in part, by higher rates of high blood pressure, diabetes and obesity that developed in these women. Although more research is needed, Mehta said the findings underscore the need to be more intensive about managing the cardiovascular risks seen with these adverse pregnancy outcomes.

"Women who experience adverse pregnancy outcomes have more risk factors for heart disease at younger ages and, ultimately, have a higher rate of [early] heart disease," Mehta said. "Even though pregnancy complications have been included in some cardiovascular disease prevention recommendations and are named as a risk enhancer in the ACC/AHA primary prevention guideline, there needs to be more intensive surveillance and screening. We are missing women at high cardiovascular risk if we don't make it routine practice to take adverse pregnancy outcomes into account when we inquire about patients' cardiovascular history."

The other challenge, she said, is that clinicians must try to engage women at a time when they are focusing their energy on motherhood and their newborn, rather than remembering to prioritize self-care.

This study is limited by its reliance on self-reported information about pregnancy history; future studies should validate with medical records and determine whether an echocardiogram could help identify women who need strategies to lower heart risks.

Mehta plans to extend this research by exploring the mechanisms that lead to these women developing heart disease in order to identify strategies for prevention before, during and after pregnancy. Her future research will be supported through the ACC/Merck Research Fellowship Award, as one of two national recipients starting in July 2020.
The study was funded by the National Institutes of Health's National Center for Advancing Translational Sciences.

ACC.20/WCC will take place March 28-30, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC20/#WCCardio for the latest news from the meeting.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care and offers cardiovascular accreditation to hospitals and institutions. For more, visit
American College of Cardiology

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.