Profile of congenital heart disease in infants born following exposure to preeclampsia

PLoS ONE, Volume 15, No. 3, Year 2020

Interpretação

Background Events in pregnancy play an important role in predisposing the newborn to the risk of developing CHD. This study evaluated the association between maternal preeclampsia and her offspring risk of CHD. Methods This is a cohort study of 90 sex-matched neonates (45 each born to women with preeclampsia and normal pregnancy) in Jos, Nigeria. Anthropometry was taken shortly after delivery using standard protocols. Echocardiography was performed within 24 hours of life and repeated 7 and 28 days later. SPSS version 25 was used in all analyses. Statistical significance was set at p<0.05. Results Congenital heart disease (CHD) was observed in 27 (30.0%) of newborns of women with preeclampsia compared with 11 (12.1%) of newborns without preeclampsia (p<0.001) at the end of 7 days and in 19 (21.1%) of newborns of women with preeclampsia and 3 (3.3%) of newborns of women without preeclampsia by the end of the 4th week of life (p<0.001). Overall, ASD (4 newborns), PDA (21 newborns), patent foramen ovale (14 newborns) and VSD (2 newborns) were the prevalent lesions found among all the newborns studied in the first week of life. Isolated atrial and ventricular septal defects were seen in 4 (4.4%) of the newborns of women with preeclampsia. Being the infant of a woman with preeclampsia was associated with about 8-fold increased risk of having CHD (OR = 7.9, 95% CI = 2.5–24.9, p<0.001). Conclusion CHD may be more common in newborns of women with preeclampsia underscoring the need for fetal and newborn screening for CHD in women with preeclampsia so as to improve their infant’s well being. We conducted this study in the 4 tertiary health facilities in Jos namely; Jos University Teaching Hospital (JUTH), Plateau Specialist Hospital (PSSH), Bingham University Teaching Hospital (BhUTH) and Our Lady of Apostle (OLA) Hospital. Each of these hospitals has specialist obstetric care services. Altogether, they have an annual delivery rate of about 14,000 babies with preeclampsia/eclampsia accounting for about 5% of the deliveries annually. This study was carried out between April 2017 and May 2018 as part of the infant outcomes study on women with preeclampsia in Jos. All the women were recruited antenatally and followed up to delivery. At delivery, all the infants had anthropometry and echocardiography done. We identified 45 newborns from women with preeclampsia at birth in the delivery room and matched them for sex with 45 newborns of women with normal pregnancy. We used OpenEpi version 3.03a to determine a minimum sample size of 80 (40 neonates in each arm) based on the estimated effect size of 20%, a power of 80% and an α level of 0.05.[13] We excluded newborns of women with other chronic disorders like diabetes, HIV and Sickle cell anemia in the control and exposure groups in order to avoid confounding. Ethical approval was obtained from each of the participating hospitals before commencement of the study. Written informed consent was obtained from the mothers before recruiting the newborns. Preeclampsia was defined as systolic blood pressure ≥140 mmHg or diastolic pressure ≥90 mmHg (or increases of 30 mmHg systolic or 15 mmHg diastolic from the baseline) on at least two occasions, six or more hours apart and associated proteinuria that develops from the 20th gestational week in a previously normotensive woman. This study was a cohort design that compared the spectrum of CHD in newborns of women with preeclampsia versus those with normal pregnancy in the four tertiary care centers in Jos Nigeria. Each newborn had a transthoracic echocardiography done at least 4 hours post-delivery in the nursery to assess for the presence of CHD. This was repeated for all the infants at 7 days and 28 days of life in order to exclude physiologic patent ductus arteriosus and foramen ovale. All measurements were performed according to American Society of Echocardiography guidelines by an experienced Paediatric Cardiologist.[14] Echocardiography was done following a standard examination protocol using a Vivid e ultrasound machine (General Electric, USA) equipped with a P6 Phased Array ultrasound transducer.[14] Anthropometric measurements were done by weighing each naked newborn to the nearest 50g using a way master bassinet weighing scale operated by a trained midwife. [15,16] The institutional review board of the Jos University Teaching Hospital reviewed and approved the study (JUTH/DCS/ADM/127/XIX/6632). Each infant was identified with a code that does not contain their name. Only the principal investigator has access to the database linking the name of the individual with the code. All material data including the study forms and specimen bottles were labeled accordingly with the printed unique identification numbers. Different biological fluids (i.e. serum and plasma specimen) were marked with different prefixes for ease of identification. Statistical analysis was done using SPSS version 25.[17] Mean differences in maternal age, booking weight and parity as well as infant weight and gestational age were compared between babies born following preeclamptic pregnancy and those born following normal pregnancy using a t-test. Difference in proportion of the newborns by sex as well as maternal education, fever in pregnancy, alcohol use and contraceptive use was done using 2 by 2 table cross tabulations. Spectrum of CHD was depicted using bar charts and a frequency table. Univariate analysis was done to evaluate the relationship of each of the maternal and infant variables with CHD. Those that were found to be significant were then included in Multivariable logistic regression analysis to assess the relationship between CHD and these maternal and infant characteristics. The criterion for significance for all analyses was set at a P-value of < 0.05.

AI Digest

Study Justification:

– The study aimed to evaluate the association between maternal preeclampsia and the risk of congenital heart disease (CHD) in newborns.
– This is an important area of research as events in pregnancy can increase the newborn’s risk of developing CHD.
– Understanding the relationship between preeclampsia and CHD can help improve fetal and newborn screening for CHD in women with preeclampsia, leading to better infant outcomes.

Study Highlights:

– The study included 90 neonates, with 45 born to women with preeclampsia and 45 born to women with normal pregnancy.
– Congenital heart disease (CHD) was observed in 30.0% of newborns of women with preeclampsia compared to 12.1% of newborns without preeclampsia at the end of 7 days.
– By the end of the 4th week of life, CHD was observed in 21.1% of newborns of women with preeclampsia and 3.3% of newborns of women without preeclampsia.
– The prevalent CHD lesions found were atrial septal defects (ASD), patent ductus arteriosus (PDA), patent foramen ovale (PFO), and ventricular septal defects (VSD).
– Being the infant of a woman with preeclampsia was associated with an 8-fold increased risk of having CHD.

Recommendations for Lay Reader and Policy Maker:

– The study suggests that CHD may be more common in newborns of women with preeclampsia.
– Fetal and newborn screening for CHD should be implemented in women with preeclampsia to improve infant well-being.
– Policy makers should consider incorporating CHD screening protocols for women with preeclampsia into existing healthcare systems.

Key Role Players:

– Obstetric care specialists in tertiary health facilities.
– Pediatric cardiologists experienced in echocardiography.
– Trained midwives for anthropometric measurements.
– Researchers and principal investigator for data collection and analysis.

Cost Items for Planning Recommendations:

– Training and certification of healthcare professionals in CHD screening protocols.
– Equipment and maintenance costs for echocardiography machines.
– Staff salaries and benefits for healthcare professionals involved in screening and diagnosis.
– Research funding for data collection, analysis, and publication.
– Administrative costs for organizing and implementing screening programs.
– Educational materials for raising awareness among healthcare providers and pregnant women.

Força da prova

N/A

Resumo

We conducted this study in the 4 tertiary health facilities in Jos namely; Jos University Teaching Hospital (JUTH), Plateau Specialist Hospital (PSSH), Bingham University Teaching Hospital (BhUTH) and Our Lady of Apostle (OLA) Hospital. Each of these hospitals has specialist obstetric care services. Altogether, they have an annual delivery rate of about 14,000 babies with preeclampsia/eclampsia accounting for about 5% of the deliveries annually. This study was carried out between April 2017 and May 2018 as part of the infant outcomes study on women with preeclampsia in Jos. All the women were recruited antenatally and followed up to delivery. At delivery, all the infants had anthropometry and echocardiography done. We identified 45 newborns from women with preeclampsia at birth in the delivery room and matched them for sex with 45 newborns of women with normal pregnancy. We used OpenEpi version 3.03a to determine a minimum sample size of 80 (40 neonates in each arm) based on the estimated effect size of 20%, a power of 80% and an α level of 0.05.[13] We excluded newborns of women with other chronic disorders like diabetes, HIV and Sickle cell anemia in the control and exposure groups in order to avoid confounding. Ethical approval was obtained from each of the participating hospitals before commencement of the study. Written informed consent was obtained from the mothers before recruiting the newborns. Preeclampsia was defined as systolic blood pressure ≥140 mmHg or diastolic pressure ≥90 mmHg (or increases of 30 mmHg systolic or 15 mmHg diastolic from the baseline) on at least two occasions, six or more hours apart and associated proteinuria that develops from the 20th gestational week in a previously normotensive woman. This study was a cohort design that compared the spectrum of CHD in newborns of women with preeclampsia versus those with normal pregnancy in the four tertiary care centers in Jos Nigeria. Each newborn had a transthoracic echocardiography done at least 4 hours post-delivery in the nursery to assess for the presence of CHD. This was repeated for all the infants at 7 days and 28 days of life in order to exclude physiologic patent ductus arteriosus and foramen ovale. All measurements were performed according to American Society of Echocardiography guidelines by an experienced Paediatric Cardiologist.[14] Echocardiography was done following a standard examination protocol using a Vivid e ultrasound machine (General Electric, USA) equipped with a P6 Phased Array ultrasound transducer.[14] Anthropometric measurements were done by weighing each naked newborn to the nearest 50g using a way master bassinet weighing scale operated by a trained midwife. [15,16] The institutional review board of the Jos University Teaching Hospital reviewed and approved the study (JUTH/DCS/ADM/127/XIX/6632). Each infant was identified with a code that does not contain their name. Only the principal investigator has access to the database linking the name of the individual with the code. All material data including the study forms and specimen bottles were labeled accordingly with the printed unique identification numbers. Different biological fluids (i.e. serum and plasma specimen) were marked with different prefixes for ease of identification. Statistical analysis was done using SPSS version 25.[17] Mean differences in maternal age, booking weight and parity as well as infant weight and gestational age were compared between babies born following preeclamptic pregnancy and those born following normal pregnancy using a t-test. Difference in proportion of the newborns by sex as well as maternal education, fever in pregnancy, alcohol use and contraceptive use was done using 2 by 2 table cross tabulations. Spectrum of CHD was depicted using bar charts and a frequency table. Univariate analysis was done to evaluate the relationship of each of the maternal and infant variables with CHD. Those that were found to be significant were then included in Multivariable logistic regression analysis to assess the relationship between CHD and these maternal and infant characteristics. The criterion for significance for all analyses was set at a P-value of < 0.05.

Materiais

Inovações

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can allow pregnant women with preeclampsia to have remote consultations with healthcare providers, reducing the need for frequent hospital visits and improving access to specialized care.

2. Mobile health (mHealth) applications: Developing mobile applications that provide educational resources, reminders for medication and appointments, and personalized health information can empower women with preeclampsia to actively manage their condition and improve their overall health outcomes.

3. Community-based prenatal care: Establishing community-based prenatal care programs can bring healthcare services closer to pregnant women, particularly those in remote or underserved areas. This approach can include regular check-ups, education sessions, and support groups, ensuring that women with preeclampsia receive the necessary care and support throughout their pregnancy.

4. Training and capacity building: Investing in training healthcare providers, particularly in areas with high rates of preeclampsia, can improve the detection, management, and treatment of the condition. This can include specialized training in obstetric care, neonatal screening, and echocardiography.

5. Public awareness campaigns: Launching public awareness campaigns can help educate communities about the signs and symptoms of preeclampsia, the importance of early detection, and the available healthcare services. This can encourage women to seek timely care and improve access to maternal health services.

6. Collaborative care models: Implementing collaborative care models that involve multidisciplinary teams, including obstetricians, cardiologists, and neonatologists, can ensure comprehensive and coordinated care for women with preeclampsia and their infants. This approach can improve communication, streamline care processes, and enhance overall health outcomes.

It is important to note that the implementation of these innovations should be context-specific and consider the local healthcare infrastructure, resources, and cultural factors.

AI Innovations Description

Based on the information provided, the recommendation to improve access to maternal health and address the findings of the study on the association between maternal preeclampsia and the risk of congenital heart disease (CHD) in newborns is to implement fetal and newborn screening for CHD in women with preeclampsia. This recommendation aims to identify and diagnose CHD in newborns of women with preeclampsia early on, allowing for appropriate medical interventions and care to improve the well-being of the infants. By conducting transthoracic echocardiography shortly after delivery and repeating it at 7 and 28 days of life, healthcare providers can assess for the presence of CHD and exclude physiologic conditions such as patent ductus arteriosus and foramen ovale. This screening process should be carried out in tertiary health facilities that have specialist obstetric care services, such as the ones mentioned in the study (Jos University Teaching Hospital, Plateau Specialist Hospital, Bingham University Teaching Hospital, and Our Lady of Apostle Hospital). It is important to obtain ethical approval and written informed consent from the mothers before recruiting the newborns for screening. Additionally, healthcare providers should receive proper training and follow the American Society of Echocardiography guidelines for conducting echocardiography. The data collected during the screening process should be appropriately labeled and stored securely to ensure privacy and confidentiality. Statistical analysis using software like SPSS can be used to evaluate the relationship between CHD and maternal and infant characteristics. The implementation of fetal and newborn screening for CHD in women with preeclampsia can contribute to improving access to maternal health and the early detection and management of CHD in newborns.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement comprehensive education programs to raise awareness about the importance of maternal health and the risks associated with conditions like preeclampsia. This can include community outreach programs, workshops, and campaigns targeting both pregnant women and healthcare providers.

2. Strengthen antenatal care services: Enhance antenatal care services by ensuring regular check-ups, early detection of preeclampsia, and appropriate management. This can involve training healthcare providers, improving infrastructure and equipment, and implementing standardized protocols for screening and management of preeclampsia.

3. Improve access to specialized care: Establish referral systems and improve access to specialized obstetric care facilities for women with preeclampsia. This can involve strengthening the capacity of tertiary health facilities, ensuring availability of skilled healthcare professionals, and providing transportation services for pregnant women in need of specialized care.

4. Implement screening programs: Introduce routine screening programs for congenital heart disease (CHD) in newborns of women with preeclampsia. This can help in early detection and timely intervention, leading to improved outcomes for infants with CHD.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population that will be affected by the recommendations, such as pregnant women with preeclampsia in a particular region or healthcare facility.

2. Collect baseline data: Gather data on the current state of access to maternal health services, including the prevalence of preeclampsia, availability of antenatal care, and rates of CHD in newborns.

3. Define indicators: Determine key indicators to measure the impact of the recommendations, such as the percentage increase in antenatal care coverage, reduction in maternal and infant mortality rates, and improvement in early detection of CHD.

4. Develop a simulation model: Use statistical software or modeling techniques to create a simulation model that incorporates the baseline data and the potential impact of the recommendations. This model should consider factors such as population size, healthcare infrastructure, and resource allocation.

5. Simulate scenarios: Run simulations using different scenarios, varying the implementation of the recommendations. This can help assess the potential impact of each recommendation individually and in combination.

6. Analyze results: Evaluate the simulation results to determine the potential impact of the recommendations on improving access to maternal health. This can involve comparing indicators between different scenarios and identifying the most effective strategies.

7. Refine and validate the model: Continuously update and refine the simulation model based on new data and feedback from stakeholders. Validate the model by comparing the simulation results with real-world outcomes, if possible.

By following this methodology, policymakers and healthcare providers can gain insights into the potential benefits of implementing specific recommendations to improve access to maternal health and make informed decisions on resource allocation and program implementation.

Autores & Coautores

Statistics:

Citations: 7

Authors: 13

Identifiers:

DOI: 10.1371/journal.pone.0229987

Research Areas:

Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health, Substance Abuse

Study Countries:

Nigeria

Study Design:

Cohort Study

Study Approach:

Quantitative

Participants Gender:

Female

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