SPC365

Impact of Maternal-Fetal Outcomes and Breastfeeding on Cardiac Reverse Remodeling

Session: SESSÃO DE POSTERS 46 - EPIDEMIOLOGIA PORTUGUESA NO FOCO
Speaker: Rui Martins Alves

Congress: CPC 2025
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.7 Pregnancy and Cardiovascular Disease
Session Type: Cartazes
FP Number: ---
Authors: Rui Martins Alves; Ana Filipa Ferreira; Ana Barros; Juliana Morais; Débora Veiga; Maria João Azevedo; Carla Sousa; Ana Paula Machado; Adelino Leite-Moreira; Carla Ramalho; Inês Falcão-Pires; António S. Barros

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Pregnancy induces cardiac remodeling characterized by left ventricular (LV) hypertrophy and dilation, which is expected to return to its pre-pregnancy structure after delivery, cardiac reverse remodeling (RR).&nbsp;However, the impact of maternal-fetal outcomes and breastfeeding on cardiac RR is not yet well established.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To investigate the impact of maternal-fetal outcomes [cardiovascular risk (CVR) factors (chronic arterial hypertension, obesity, and type 2 diabetes mellitus), pregnancy complications (preeclampsia, gestational diabetes and gestational hypertension), duration, parity, newborn sex, delivery type], and exclusive breastfeeding on LV mass (LVM) regression induced by pregnancy.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: This prospective cohort study included volunteer pregnant women from two tertiary centers between 2019 and 2024. Participants underwent transthoracic echocardiography during the 3</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>rd</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> trimester [30&ndash;35 weeks, peak of cardiac remodeling], as well as at 1/6/12 months postpartum [cardiac RR]. Generalized linear mixed-effects models were used to evaluate the extent of the RR and its predictors.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 169 participants were included, with a median age of 34[31;37] years, 36% of whom had at least one CVR factor. Pregnancy complications occurred in 30% of the women. The median time of gestation was 39[38; 40] weeks. C-section delivery was performed in 37% of the participants, and 53% of the newborns were male. Most of the participants were primiparous (53%). Exclusive breastfeeding for up to 4.5 months was documented in 39% of women. Significant regression of LVM (34[29;39]g/m</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2.7</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> to 31[26; 36]g/m</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2.7</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">, p&lt;0.001), volume (25[22;28]mL/m</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2.7</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> to 23[20;26]mL/m</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2.7</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">, p&lt;0.001), and relative wall thickness (0.36[0.32;0.40] to 0.33[0.30;0.37], p&lt;0.001) were found as soon as 1 month postpartum.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In the multivariable analysis, the presence of maternal CVR factors (7.39[5.47;9.31], p&lt;0.001) and the number of live births before this pregnancy (1.41[0.02;2.80], p=0.048) were independent predictors of postpartum LVM regression. Pregnancy complications, newborn sex, c-section, pregnancy duration, maternal age, and exclusive breastfeeding for up to 4.5 months showed a non-significant impact on postpartum LVM regression.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Substantial LVM regression was observed as early as 1 month postpartum. The presence of maternal CVR factors and an increased number of previous live births significantly influenced cardiac RR, diminishing the regression of postpartum LVM.</span></span></span></p>