Effect of maternal cardiovascular conditions and risk factors on offspring cardiovascular disease.
Effect of maternal cardiovascular conditions and risk factors on offspring cardiovascular disease.
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DOI：
10.1161/circulationaha.113.001805
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发表时间：
2014-05-20
期刊：
影响因子：
37.8
通讯作者：
Palinski W
中科院分区：
文献类型：
--
作者：
Palinski W
心血管疾病（CVD）是妊娠期间的一个特殊挑战，因为生理变化和胎儿需求会造成额外的负担，胎儿安全问题限制了治疗选择。本系列的其他文章回顾了怀孕期间的生理变化，最有可能危及孕产妇和胎儿健康的心血管疾病的管理，以及它们对母亲心血管健康的长期影响。这篇文章主要关注它们对后代的影响。子宫内或出生后早期暴露于特定危险因素导致的发育编程越来越多地被认为是决定以后生活中CVD的因素。妊娠期临床表现的心血管疾病，如先兆子痫/子痫和妊娠期高血压，不仅可能影响孕产妇健康和妊娠结局，还可能降低胎儿生长，这与成人CVD增加有关。此外，大量证据表明，母体心血管危险因素（高胆固醇血症，吸烟，肥胖和糖尿病）程序内皮功能障碍，胰岛素抵抗（IR），高血压，动脉粥样硬化和2型糖尿病的后代。发育编程的机制在很大程度上仍然是未知的，但影响子宫内编程的具体因素已经确定，并建立了实验模型，其中因果关系，机制和母体治疗的保护作用可以探索。这些研究结果表明，针对子宫内编程的干预措施可能会降低后代对CVD的易感性，考虑到肥胖和代谢异常母亲的患病率日益增加以及儿童生活方式风险的随之增加，这是一个高度优先事项。然而，无论是许多孕产妇危险因素的心血管后果，还是孕产妇预防和治疗的有效性，都没有得到前瞻性双盲研究的充分支持。本综述提供了一个关键的评估母亲在怀孕期间的心血管疾病和后代CVD之间的关联，低出生体重的作用，和其他母亲心血管危险因素的CVD的发展规划的证据。然后，它提出了一个综合的观点，在子宫内编程的心血管疾病及其机制的基础上出现的共识，并强调未来的临床和基础研究的优先事项。最后，它讨论了针对发展规划的承诺和警告，即治疗母亲以减少后代的CVD。
Cardiovascular diseases (CVDs) constitute a particular challenge during pregnancy because physiological changes and fetal demands create an additional burden and fetal safety concerns limit treatment options. Other articles of this series review the physiological changes during pregnancy, the management of cardiovascular conditions most likely to endanger maternal and fetal health, and their long-term consequences for the cardiovascular health of the mother. This article focuses on their consequences in offspring. Developmental programming resulting from in utero or early postnatal exposure to specific risk factors is increasingly recognized to determine CVD in later life. Clinically manifest cardiovascular conditions during pregnancy such as preeclampsia/eclampsia and gestational hypertension may not only affect maternal health and pregnancy outcome but also reduce fetal growth, which is associated with increased adult CVD. Furthermore, extensive evidence indicates that maternal cardiovascular risk factors (hypercholesterolemia, smoking, obesity, and diabetes mellitus) program endothelial dysfunction, insulin resistance (IR), hypertension, atherosclerosis, and type 2 diabetes mellitus in offspring. The mechanisms of developmental programming remain largely unknown, but specific factors affecting in utero programming have been identified and experimental models established in which causal relationships, mechanisms, and protective effects of maternal treatment can be explored. These findings suggest that interventions targeting in utero programming may reduce the susceptibility to CVD in offspring, a high priority given the increasing prevalence of obese and dysmetabolic mothers and the concomitant increase in lifestyle risk in children. However, neither the cardiovascular consequences of many maternal risk factors nor the efficacy of maternal prevention and treatment is sufficiently supported by prospective double-blind studies. The present review provides a critical evaluation of the associations between maternal cardiovascular conditions during pregnancy and offspring CVD, the role of low birth weight, and the evidence for developmental programming of CVD by other maternal cardiovascular risk factors. It then proposes an integrated view of in utero programming of CVD and its mechanisms based on emerging consensus and highlights priorities for future clinical and basic research. Finally, it discusses the promises and caveats of targeting developmental programming, that is, treating mothers to reduce CVD in offspring.