The effect of hypertension in pregnancy and central nervous system anomalies on fetal brain development

Yıl 2023, Cilt: 9 Sayı: 6 - November 2023, 1429 - 1437, 04.11.2023

Mehmet Albayrak M. Faruk Köse Banu Anlar

https://doi.org/10.18621/eurj.1249233

Öz

Objectives: The aim of this study was to investigate whether maternal hypertension affects fetal brain maturation, and to examine whether treatment with magnesium sulfate has a protective effect on the fetal brain.

Methods: A total of 26 fetuses, including 11 dead fetuses of pregnant women who were found to have hypertension and whose pregnancy was terminated due to this reason, and 15 fetuses who did not have this risk factor but died for various reasons as the control group, were included in the study. Brain tissue samples were evaluated for the presence of morphological and histopathological changes, as well as apoptotic cells. The morphologies of the samples were examined in sections stained with hematoxylin-eosin (H&E), and apoptosis was examined with light microscopy by the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) method.

Results: In the control group, it was observed that the brain tissue had a morphological structure compatible with the development weeks. In the hypertension group, there were no bleeding foci and brain tissues mostly preserved morphological features similar to control patients. While edema was detected in 45.4% of the infants in the hypertension group, no edema was observed in 54.6%. In the hypertension group, Grade 1 necrosis was observed in 63.6% of the samples, Grade 2 necrosis was observed in 9.1%, and no necrosis was observed in 27.3% of the samples.

Conclusions: Based on the findings of this study, it can be concluded that maternal hypertension increases neurological maturation by causing vasodilation in the fetal brain, increasing blood flow, and decreasing cell death.

Anahtar Kelimeler

Maternal hypertension, fetal development, brain, edema, hemorrhage, necrosis, apoptosis

Kaynakça

• 1. Williams K, Carson J, Lo C. Genetics of congenital heart disease. Biomolecules 2019;9:879.
• 2. Cuneo BF, Curran LF, Davis N, Elrad H. Trends in prenataldiagnosis of critical cardiac defects in an integrated obstetricand pediatric cardiac imaging center. J Perinatol 2004;24:674-8.
• 3. van der Bom T, Zomer AC, Zwinderman AH, Meijboom FJ, Bouma BJ, Mulder BJM. The changing epidemiology of congenital heart disease. Nat Rev Cardiol 2011;8:50-60.
• 4. Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990-2017. Medicine (Baltimore) 2020;99:e20593.
• 5. Van Velzen CL, Ket JCF, Van de Ven PM, Blom NA, Haak NC. Systematic review and meta-analysis of the performance of second-trimester screening for prenatal detection of congenital heart defects. Int J Gynaecol Obstet 2018;140:137-45.
• 6. Marino B, Digilio MC, Toscano A, Giannotti A, Dallapiccola B. Congenital heart diseases in children with Noonan syndrome: an expanded cardiac spectrum with high prevalence of atrioventricular canal. J Pediatr 1999;135:703-6.
• 7. Celep G, Ogur G, Gunal N, Baysal K. DiGeorge syndrome (Chromosome 22q11.2 deletion syndrome): a historical perspective with review of 66 patients. J Surg Med 2019;3:58-63.
• 8. Pierpont ME, Basson CT, Benson DW, Belb BD, Giglia TM, Goldmuntz E, et al. Genetic basis for congenital heart defects: current knowledge. Circulation 2007;115:3015-38.
• 9. Roodpeyma S, Kamali Z, Ashar F, Naraghi S. Risk factors in congenital heart disease. Clin Pediatr (Phila) 2002;41:653-8.
• 10. Hartman RJ, Rasmussen SA, Botto LD, Riehle-Colarusso T, Martin CL, Cragan JD, et al. The contribution of chromosomal abnormalities to congenital heart defects: a population-based study. Pediatr Cardiol 2011;32:1147-57.
• 11. Paladini D, Tartaglione A, Agangi A, Teodoro A, Forlogo F, Borghese A, et al. The association between congenital heart disease and Down syndrome in prenatal life. Ultrasound Obstet Gynecol 2000:15:104-8.
• 12. Ballweg JA, Wernovsky G, Gaynor JW. Neurodevelopmental outcomes following congenital heart surgery. Pediatr Cardiol 2007;28:126-33.
• 13. Arduini M, Rosati P, Caforio L, Guariglia L, Clerici G, Di Renzo GC, et al. Cerebral blood flow autoregulation and congenital heart disease: possible causes of abnormal prenatal neurologic development. J Matern Fetal Neonatal Med 2011;24:1208-11.
• 14. Morton PD, Ishibashi N, Jonas RA. Neurodevelopmental abnormalities and congenital heart disease: insights into altered brain maturation. Circ Res 2017;120:960-77.
• 15. Maulik D, You Laggda AP , Younghood JP, Willonghy L. Componets of variability of umbilical arterial Doppler a prospective analysis, Am J Obstet Gynecol 1989;160:1406-12.
• 16. Clerici G, Luzietti R, Cutuli A, Direnzo GC. Cerebral hemodynamics and fetal behavioral states. Ultrasound Obstet Gynecol 2002;19:340-3.
• 17. Wolf H, Stampalija T, Lees CC; TRUFFLE Study Group. Fetal cerebral blood-flow redistribution: analysis of Doppler reference charts and association of different thresholds with adverse perinatal outcome. Ultrasound Obstet Gynecol 2021;58:705-15.
• 18. Barzilay E, Hass J, de Castro H, Yinon Y, Achiron R, Gilboa Y. Measurement of middle cerebral artery diameter as a method for assessment of brain sparing in intra-uterine growth-restricted discordant twins. Prenat Diagn 2015;35:137-41.
• 19. Gielecki J, Zurada A, Kozłowska H, Nowak D, Loukas M. Morphometric and volumetric analysis of the middle cerebral artery in human fetuses. Acta Neurobiol Exp (Wars) 2009;69:129-37.
• 20. Vena F, Manganaro L, D'Ambrosio V, Masciullo L, Ventriglia F, Ercolani G, et al. Neuroimaging and cerebrovascular changes in fetuses with complex congenital heart disease. J Clin Med 2022;11:6740.
• 21. Hahn E, Szwast A, Cnota J, Levine JC, Fifer CG, Jaeggi E, et al. Association between fetal growth, cerebral blood flow and neurodevelopmentaloutcome in univentricular fetuses. Ultrasound Obstet Gynecol 2016;47:460-5.
• 22. Masoller N, Martinez JM, Gomez O, Bennasar M, Crispi F, Sanz-Cortes M, et al. Evidence of second- trimesterchanges in head biometry and brain perfusion in fetuses with congenital heart disease. Ultrasound Obstet Gynecol 2014;44:182-7.
• 23. Ancel PY, Livinec F, Larroque B, Marret S, Arnaud C, Pierrat V, et al; EPIPAGE Study Group. Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study. Pediatrics 2006;117:828-35.
• 24. Tarzamni MK, Nezami N, Sobhani N, Eshraghi N, Tarzamni M, Talebi Y .Nomograms of Iranian fetal middle cerebral artery Doppler waveforms and uniformity of their pattern with other populations' nomograms. BMC Pregnancy and Childbirth 2008;8:50.
• 25. Zloto K, Hochberg A, Tenenbaum-Gavish K, Berezowsky A, Barbara-Hazan S, Bardin R, et al. Fetal congenital heart disease - mode of delivery and obstetrical complications. BMC Pregnancy Childbirth 2022;22:578.
• 26. Zeng S, Zhou J, Peng Q, Tian L, Xu G, Zhao Y, et al. Assessment by three-dimensional power Doppler ultrasound of cerebral blood flow perfusion in fetuses with congenital heart disease. Ultrasound Obstet Gynecol 2015;45:649-56.
• 27. Euser AG, Cipolla MJ. Magnesium sulfate for the treatment of eclampsia: a brief review. Stroke 2009;40:1169-75.
• 28. Yamanaka R, Shindo Y, Oka K. Magnesium is a key player in neuronal maturation and neuropathology. Int J Mol Sci 2019;20:3439.
• 29. Maršál K. Physiological adaptation of the growth-restricted fetus. Best Pract Res Clin Obstet Gynaecol 2018;49:37-52.