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Cardiovascular Health in Pregnancy and the Off-Spring

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 9264

Special Issue Editors


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Guest Editor
1. Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
2. Department of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
Interests: fetal arrhythmia; fetal magnetocardiography; fetal cardiology; fetal programming of cardiovascular disease in childhood
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
1. Department of Sports and Health Sciences, Institute of Preventive Pediatrics, Technical University Munich, Georg Brauchle Ring, 80992 Munich, Germany
2. Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
Interests: fetal cardiology; physical activity and child health; vascular phenotyping; cardiovascular prevention in childhood and adolescence
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
1. Department of Pediatriac and Fetal Cardiology, Children´s Heart Center, Karolinska University Hospital, Stockholm, Sweden
2. Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
Interests: fetal arrhythmia; fetal magnetocardiography; fetal cardiology; fetal programming of cardiovascular disease in childhood, prenatal nicotine exposure, cardiac function in congenital diaphragmatic hernia

Special Issue Information

Dear Colleagues,

High-risk pregnancies are a common public health problem. Fetal programming is major issue in this field. Theory suggests that environmental influences during fetal development have a critical impact on health and disease development across the lifespan. Lifestyle, psychosocial, environmental and genetic factors could all lead to health issues and cardiovascular sequelae. Successful interventions to reduce physical inactivity, unhealthy nutrition, and sedentary behavior have the potential to positively affect maternal and fetal health in pregnancy and in the health of offspring.  In addition, fetal congenital heart disease and fetal arrhythmia are still main topics of cardiovascular medicine. In this Special Issue we would like to focus on these topics in maternal and fetal health during pregnancy and in the health of offspring.

Dr. Annette Wacker-Gussmann
Prof. Dr. Renate Oberhoffer-Fritz
Dr. Felicia Nordenstam
Guest Editors

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Keywords

  • fetal
  • pregnancy
  • cardiovascular health
  • lifestyle factors
  • fetal arrhythmia
  • congenital heart defects
  • physical activity
  • nutrition
  • sudden cardiac death

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Published Papers (5 papers)

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Editorial

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2 pages, 161 KiB  
Editorial
Cardiovascular Health in Pregnant Women and Their Off-Spring
by Gizem Seyda Erbas, Felicia Nordenstam, Renate Oberhoffer-Fritz, Christina Sitzberger and Annette Wacker-Gußmann
J. Clin. Med. 2023, 12(9), 3293; https://doi.org/10.3390/jcm12093293 - 5 May 2023
Viewed by 968
Abstract
Child development requires complex interactions between the pregnant woman and the growing child [...] Full article
(This article belongs to the Special Issue Cardiovascular Health in Pregnancy and the Off-Spring)

Research

Jump to: Editorial, Review

9 pages, 562 KiB  
Article
Fetal Heart Rate < 3rd Percentile for Gestational Age Can Be a Marker of Inherited Arrhythmia Syndromes
by Nadia Chaudhry-Waterman, Bharat Dara, Emily Bucholz, Camila Londono Obregon, Michelle Grenier, Kristen Snyder and Bettina F. Cuneo
J. Clin. Med. 2023, 12(13), 4464; https://doi.org/10.3390/jcm12134464 - 3 Jul 2023
Cited by 3 | Viewed by 1630
Abstract
Background: Repeated fetal heart rates (FHR) < 3rd percentile for gestational age (GA) with 1:1 atrioventricular conduction (sinus bradycardia) can be a marker for long QT syndrome. We hypothesized that other inherited arrhythmia syndromes might present with fetal sinus bradycardia. Methods: We reviewed [...] Read more.
Background: Repeated fetal heart rates (FHR) < 3rd percentile for gestational age (GA) with 1:1 atrioventricular conduction (sinus bradycardia) can be a marker for long QT syndrome. We hypothesized that other inherited arrhythmia syndromes might present with fetal sinus bradycardia. Methods: We reviewed pregnancies referred with sinus bradycardia to the Colorado Fetal Care Center between 2013 and 2023. FHR/GA data, family history, medication exposure, normalized isovolumic contraction times (n-IVRT), postnatal genetic testing, and ECGs at 4–6 weeks after birth were reviewed. Results: Twenty-nine bradycardic subjects were evaluated by fetal echocardiography. Five were lost to follow-up, one refused genetic testing, and one had negative genetic testing for any inherited arrhythmia. Six had non-genetic causes of fetal bradycardia with normal prenatal n-IVRT and postnatal QTc. Thirteen carried pathogenic variants in RYR2 (n = 2), HCN4 (n = 2), KCNQ1 (6), and other LQTS genes (n = 4). The postnatal QTc was <470 ms in subjects with RYR2, HCN4, and two of those with KCNQ1 mutations, and >470 ms in subjects with CALM 2, KCNH2, SCN5A, and four of those with KCNQ1 mutations. LQTS and RYR2 mutations were associated with prolonged n-IVRT, but HCN4 was not. Two fetuses died in utero with variants of uncertain significance (CACNA1 and KCNE1). Cascade testing uncovered six affected but undiagnosed parents and confirmed familial inheritance in five. Conclusion: In addition to heralding LQTS, repeated FHR < 3rd percentile for GA is a risk factor for other inherited arrhythmia syndromes. These findings suggest that genetic testing should be offered to infants with a history of FHR < 3rd percentile for GA even if the postnatal ECG demonstrates a normal QTc interval. Full article
(This article belongs to the Special Issue Cardiovascular Health in Pregnancy and the Off-Spring)
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11 pages, 2633 KiB  
Article
Ferrite Shield to Enhance the Performance of Optically Pumped Magnetometers for Fetal Magnetocardiography
by Gabriela P. Tardelli, Tan Phan, Janette Strasburger, Oswaldo Baffa and Ronald Wakai
J. Clin. Med. 2023, 12(9), 3078; https://doi.org/10.3390/jcm12093078 - 24 Apr 2023
Cited by 3 | Viewed by 1786
Abstract
Fetal magnetocardiography (fMCG) has proven to be an important tool for the prenatal monitoring of electrical cardiac activity; however, the high cost of superconducting quantum instrumentation (SQUID) poses a limitation for the dissemination of fMCG as a routine clinical technique. Recently, optically pumped [...] Read more.
Fetal magnetocardiography (fMCG) has proven to be an important tool for the prenatal monitoring of electrical cardiac activity; however, the high cost of superconducting quantum instrumentation (SQUID) poses a limitation for the dissemination of fMCG as a routine clinical technique. Recently, optically pumped magnetometers (OPMs) operating within person-sized, cylindrical shields have made fMCG more practical, but environmental magnetic interference entering through the shield opening substantially degrades the quality of fMCG signals. The goal of this study was to further attenuate these interferences by placing the OPM array within a small ferrite shield. FMCG recordings were made with and without the ferrite shield in ten subjects inside a person-sized, three-layer mu-metal cylindrical shield. Although the fetal signal was slightly attenuated, the environmental interference was reduced substantially, and maternal interference was also diminished. This increased the signal-to-noise ratio significantly and improved the resolution of the smaller waveform components. The performance improvement was highest in the axial direction and compensated for a major weakness of open-ended, person-sized shields. The ferrite shield is especially beneficial for the deployment of triaxial OPM sensors, which require effective shielding in all directions. Full article
(This article belongs to the Special Issue Cardiovascular Health in Pregnancy and the Off-Spring)
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16 pages, 1943 KiB  
Article
Left Ventricular Diastolic Function in Subjects Conceived through Assisted Reproductive Technologies
by Franziska Sciuk, Theresa Vilsmaier, Marie Kramer, Magdalena Langer, Brenda Kolbinger, Pengzhu Li, André Jakob, Nina Rogenhofer, Robert Dalla-Pozza, Christian Thaler, Nikolaus Alexander Haas and Felix Sebastian Oberhoffer
J. Clin. Med. 2022, 11(23), 7128; https://doi.org/10.3390/jcm11237128 - 30 Nov 2022
Cited by 8 | Viewed by 2036
Abstract
Subjects conceived through assisted reproductive technologies (ART) potentially suffer from impaired left ventricular (LV) function due to premature vascular aging. This study aimed to evaluate whether subtle differences in LV diastolic function can be observed echocardiographically between young ART subjects and their spontaneously [...] Read more.
Subjects conceived through assisted reproductive technologies (ART) potentially suffer from impaired left ventricular (LV) function due to premature vascular aging. This study aimed to evaluate whether subtle differences in LV diastolic function can be observed echocardiographically between young ART subjects and their spontaneously conceived peers. The echocardiographic assessment included the measurement of LV dimensions, mitral inflow velocities, and myocardial velocity at early diastole (E’, cm/s) at the LV wall and the interventricular septum (IVS). An average from E/E’LV and E/E’IVS (E/E’AVG) was derived. In total, 66 ART subjects and 83 controls (12.85 ± 5.80 years vs. 13.25 ± 5.89 years, p = 0.677) were included. The ART subjects demonstrated a significantly lower E’LV (19.29 ± 3.29 cm/s vs. 20.67 ± 3.78 cm/s, p = 0.020) compared to their spontaneously conceived peers. Study participants of ≥ 10 years of age displayed a significantly higher E/E’AVG (6.50 ± 0.97 vs. 6.05 ± 0.99, p = 0.035) within the ART cohort. The results of this study demonstrate a significantly lower LV diastolic function in the ART subjects. However, no significant changes in LV diastolic function were observed between the two groups when the results were adjusted for age, birth weight percentile, and gestational age. Those ART subjects born preterm might have an elevated risk of developing LV diastolic alterations and could therefore profit from close echocardiographic monitoring. Full article
(This article belongs to the Special Issue Cardiovascular Health in Pregnancy and the Off-Spring)
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Review

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11 pages, 1530 KiB  
Review
Preventing and Treating Torsades de Pointes in the Mother, Fetus and Newborn in the Highest Risk Pregnancies with Inherited Arrhythmia Syndromes
by Annette Wacker-Gussmann, Gretchen K. Eckstein and Janette F. Strasburger
J. Clin. Med. 2023, 12(10), 3379; https://doi.org/10.3390/jcm12103379 - 10 May 2023
Cited by 2 | Viewed by 2250
Abstract
The number of women of childbearing age who have been diagnosed in childhood with ion channelopathy and effectively treated using beta blockers, cardiac sympathectomy, and life-saving cardiac pacemakers/defibrillators is increasing. Since many of these diseases are inherited as autosomal dominant, offspring have about [...] Read more.
The number of women of childbearing age who have been diagnosed in childhood with ion channelopathy and effectively treated using beta blockers, cardiac sympathectomy, and life-saving cardiac pacemakers/defibrillators is increasing. Since many of these diseases are inherited as autosomal dominant, offspring have about a 50% risk of having the disease, though many will be only mildly impacted during fetal life. However, highly complex delivery room preparation is increasingly needed in pregnancies with inherited arrhythmia syndromes (IASs). However, specific Doppler techniques show meanwhile a better understanding of fetal electrophysiology. The advent of fetal magnetocardiography (FMCG) now allows the detection of fetal Torsades de Pointes (TdP) ventricular tachycardia and other LQT-associated arrhythmias (QTc prolongation, functional second AV block, T-wave alternans, sinus bradycardia, late-coupled ventricular ectopy and monomorphic VT) in susceptible fetuses during the second and third trimester. These types of arrhythmias can be due to either de novo or familial Long QT Syndrome (LQTS), Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), or other IAS. It is imperative that the multiple specialists involved in the antenatal, peripartum, and neonatal care of these women and their fetuses/infants have the optimal knowledge, training and equipment in order to care for these highly specialized pregnancies and deliveries. In this review, we outline the steps to recognize symptomatic LQTS in either the mother, fetus or both, along with suggestions for evaluation and management of the pregnancy, delivery, or post-partum period impacted by LQTS. Full article
(This article belongs to the Special Issue Cardiovascular Health in Pregnancy and the Off-Spring)
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