Maternal Vascular Dysfunction in Congenital Heart Defects

Abstract

Background: Research on fetal congenital heart defect (CHD) mostly focuses on etiology and mechanisms. How-ever, studies on maternal complications or pathophysiology are limited. Our objective was to determine whether vascular dysfunction exists in pregnant women carrying a fetus with congenital heart defects. Methods: We con-ducted a case-control study. 27 cases of pregnant women carrying a fetus with major CHD admitted to our hospital for delivery between April 2021 and August 2022 were selected. Every case was matched with about 2 pregnant complication-free controls without fetal abnormalities. The proangiogenic and anti-angiogenic factors and pregnancy outcomes were compared. Results: The proangiogenic factors include vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). The anti-angiogenic factors involve soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng). No differences were found in maternal plasma concentrations of PlGF, VEGF, and sFlt-1 between case-control groups when analyzed at 36 weeks ≤ gestational age (GA) < 39 weeks and 39 weeks ≤ GA ≤ 41 weeks. The concentrations of sEng in maternal plasma in the fetal CHD group were significantly higher than those in the control group: 0.60 (0.77) vs. 0.32 (0.26) ng/ml at 36 weeks ≤ GA < 39 weeks, p = 0.001 and 0.75 (0.55) vs. 0.28 (0.27) ng/ml at 39 weeks ≤ GA ≤ 41 weeks, p < 0.001. Conclusion: Vascular dysfunction exists in pregnant women with fetal congenital heart defects, manifesting significantly elevated sEng concentration at delivery.