MRI Assessed Cardiac Structure and Function in Young Adult Offspring of Hypertensive Pregnancies: a 27-year prospective Follow-up birth cohort

Background: Echocardiographic studies have demonstrated cardiac changes in offspring of individuals with hypertension during pregnancy. Cardiovascular magnetic resonance imaging (CMR) is the gold-standard for assessing cardiac structure and function. We investigated whether hypertensive pregnancies were associated with differences in CMR parameters in offspring. Methods: Offspring of women enrolled during pregnancy in the Raine Study underwent CMR at age 27 years. CMR was analysed by blinded investigators. Offspring were stratified according to whether they were born to hypertensive (HTN) pregnancies vs normotensive pregnancies. Subgroup analysis was performed comparing the offspring of pregnancy with complicated HTN (proteinuria or pre-term delivery) vs pregnancy with uncomplicated HTN. Separate analyses were conducted by sex. Multivariate linear regression analyses were performed. Results: Of 867 offspring (441 [50.9%] female), 213 (24.6%) were from a HTN pregnancy, of which 37 (17.4%) were complicated HTN. Systolic blood pressure was significantly higher in those born to HTN pregnancy vs normotensive pregnancy in male (131.9±11.1 vs 128.8±11.9mmHg, p=0.015) and female offspring (118±10.3 vs 115.4±11mmHg, p=0.037). There was no significant differences in left ventricular mass index (LVMI), left ventricular global longitudinal strain and left atrial reservoir strain between normotensive vs HTN pregnancies in male (55.0±7.4 vs 56.7±7.9g/m 2 , adjusted p=0.108; −15.3±2.9 vs −15.6±2.4%, p=0.288; 26.6±7.9.6 vs 26.6±7.8%, p=0.963) and female offspring (41.8±5.1 vs 42.6±5.6g/m 2 , p=0.223; −17.5±2.7 vs −17.9±2.5%, p=0.177; 32.5±9.1 vs 33.1±8.7%, p=0.582). Female offspring of pregnancies with complicated HTN had significantly lower LVMI compared with uncomplicated HTN (39.4±3.2 vs 43.2±5.8g/m 2 , p=0.010). Conclusion: In the largest prospective CMR study, hypertensive pregnancy was not associated with adverse changes in cardiac structure and function in young adult offspring.