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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Common carotid artery intima-media thickness increases throughout the pregnancy cycle: a prospective cohort study

Authors: Nancy Anderson Niemczyk, Marianne Bertolet, Janet M. Catov, Mansi Desai, Candace K. McClure, James M. Roberts, Akira Sekikawa, Ping Guo Tepper, Emma J. Barinas-Mitchell

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

High parity is associated with greater cardiovascular disease (CVD) among mid-life and older women. Prospective studies of arterial change throughout pregnancy are needed to provide insight into potential mechanisms. This study assessed vascular adaptation across pregnancy in healthy first-time pregnant women.

Methods

The Maternal Vascular Adaptation to Healthy Pregnancy Study (Pittsburgh, PA, 2010–2015) assessed 37 primigravid women each trimester, 6–8 weeks after delivery and 1–5 years postpartum, with B-mode ultrasound imaging of common carotid artery (CCA) intima-media thickness (IMT) and inter-adventitial diameter (IAD) to assess associations with physical and cardiometabolic measures.

Results

Thirty-seven women (age 28.2 ± 4.5 years, pre-pregnant BMI 24.4 ± 3.2 kg/m2) experienced uncomplicated pregnancies. After adjustment for age and pre-pregnancy BMI, mean (SE) IAD (mm) increased each trimester, from 6.38 (0.08) in the 1st trimester to 6.92 (0.09) in the 3rd trimester, and then returned to 1st trimester levels postpartum (6.35 [0.07], P <  0.001). In contrast, mean (SE) CCA IMT (mm) increased from the 2nd trimester (i.e., 0.546 [0.01]) onward, and remained higher at an average of 2.7 years postpartum (0.581 [0.02], P = 0.03). Weight partially explained changes in IAD.

Conclusions

In uncomplicated first pregnancies, IAD increased and returned to 1st trimester levels postpartum. In contrast, CCA IMT remained increased 2 years postpartum. Maternal weight explained vascular changes better than did metabolic changes. Increased postpartum CCA IMT may persist and contribute to long-term CVD risk.
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Literature
1.
Parikh NI, Cnattingius S, Dickman PW, Mittleman MA, Ludvigsson JF, Ingelsson E. Parity and risk of later-life maternal cardiovascular disease. Am Heart J. 2010;159(2):215–21. e216CrossRefPubMed
2.
Bertuccio P, Tavani A, Gallus S, Negri E, La Vecchia C. Menstrual and reproductive factors and risk of non-fatal acute myocardial infarction in Italy. Eur J Obstet Gynecol Reprod Biol. 2007;134(1):67–72.CrossRefPubMed
3.
Ness RB, Harris T, Cobb J, Flegal KM, Kelsey JL, Balanger A, Stunkard AJ, D'Agostino RB. Number of pregnancies and the subsequent risk of cardiovascular disease. NEnglJMed. 1993;328(21):1528–33.CrossRef
4.
Ness RB, Schotland HM, Flegal KM, Shofer FS. Reproductive history and coronary heart disease risk in women. EpidemiolRev. 1994;16(2):298–314.
5.
Akhter T, Larsson A, Larsson M, Wikstrom AK, Naessen T. Artery wall layer dimensions during normal pregnancy: a longitudinal study using noninvasive high-frequency ultrasound. Am J Physiol Heart Circ Physiol. 2013;304(2):H229–34.CrossRefPubMed
6.
Skilton MR, Bonnet F, Begg LM, Juonala M, Kahonen M, Lehtimaki T, Viikari JS, Raitakari OT. Childbearing, child-rearing, cardiovascular risk factors, and progression of carotid intima-media thickness: the cardiovascular risk in young Finns study. Stroke. 2010;41(7):1332–7.CrossRefPubMed
7.
Mersich B, Rigo J Jr, Besenyei C, Lenard Z, Studinger P, Kollai M. Opposite changes in carotid versus aortic stiffness during healthy human pregnancy. ClinSci(Lond). 2005;109(1):103–7.
8.
Visontai Z, Lenard Z, Studinger P, Rigo J Jr, Kollai M. Impaired baroreflex function during pregnancy is associated with stiffening of the carotid artery. Ultrasound ObstetGynecol. 2002;20(4):364–9.
9.
Sator MO, Joura EA, Gruber DM, Obruca A, Zeisler H, Egarter C, Huber JC. Non-invasive detection of alterations of the carotid artery in pregnant women with high-frequency ultrasound. Ultrasound ObstetGynecol. 1999;13(4):260–2.
10.
Iacobaeus C, Andolf E, Thorsell M, Bremme K, Jorneskog G, Ostlund E, Kahan T. Longitudinal study of vascular structure and function during normal pregnancy. Ultrasound Obstet Gynecol. 2017;49(1):46–53.CrossRefPubMed
11.
Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography carotid intima-media thickness task force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93–111. quiz 189-190CrossRefPubMed
12.
Bonithon-Kopp C, Touboul PJ, Berr C, Magne C, Ducimetiere P. Factors of carotid arterial enlargement in a population aged 59 to 71 years: the EVA study. Stroke. 1996;27(4):654–60.CrossRefPubMed
13.
Polak JF, Wong Q, Johnson WC, Bluemke DA, Harrington A, O'Leary DH, Yanez ND. Associations of cardiovascular risk factors, carotid intima-media thickness and left ventricular mass with inter-adventitial diameters of the common carotid artery: the multi-ethnic study of atherosclerosis (MESA). Atherosclerosis. 2011;
14.
Joensuu T, Salonen R, Winblad I, Korpela H, Salonen JT. Determinants of femoral and carotid artery atherosclerosis. J Intern Med. 1994;236(1):79–84.CrossRefPubMed
15.
Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: aging arteries: a "set up" for vascular disease. Circulation. 2003;107(1):139–46.CrossRefPubMed
16.
Eigenbrodt ML, Sukhija R, Rose KM, Tracy RE, Couper DJ, Evans GW, Bursac Z, Mehta JL. Common carotid artery wall thickness and external diameter as predictors of prevalent and incident cardiac events in a large population study. CardiovascUltrasound. 2007;5:11.
17.
Kozakova M, Morizzo C, La Carrubba S, Fabiani I, Della Latta D, Jamagidze J, Chiappino D, Di Bello V, Palombo C. Associations between common carotid artery diameter, Framingham risk score and cardiovascular events. Nutr Metab Cardiovasc Dis. 2017; 27(4):329–34.
18.
Wendelhag I, Gustavsson T, Suurkula M, Berglund G, Wikstrand J. Ultrasound measurement of wall thickness in the carotid artery: fundamental principles and description of a computerized analysing system. Clin Physiol. 1991;11(6):565–77.CrossRefPubMed
19.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed
20.
Friedewald W, Levy R, Fredrickson D. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.PubMed
21.
Bucolo G, David H. Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem. 1973;19(5):476–82.PubMed
22.
Bondar RJ, Mead DC. Evaluation of glucose-6-phosphate dehydrogenase from Leuconostoc mesenteroides in the hexokinase method for determining glucose in serum. Clin Chem. 1974;20(5):586–90.PubMed
23.
Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRefPubMed
24.
25.
Carallo C, Irace C, Pujia A, De Franceschi MS, Crescenzo A, Motti C, Cortese C, Mattioli PL, Gnasso A. Evaluation of common carotid hemodynamic forces. Relations with wall thickening. Hypertension. 1999;34(2):217–21.CrossRefPubMed
26.
Lakatta EG. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part III: cellular and molecular clues to heart and arterial aging. Circulation. 2003;107(3):490–7.CrossRefPubMed
27.
Humphries KH, Westendorp IC, Bots ML, Spinelli JJ, Carere RG, Hofman A, Witteman JC. Parity and carotid artery atherosclerosis in elderly women: the Rotterdam study. Stroke. 2001;32(10):2259–64.CrossRefPubMed
28.
Wolff B, Volzke H, Robinson D, Schwahn C, Ludemann J, Kessler C, John U, Felix SB. Relation of parity with common carotid intima-media thickness among women of the study of health in Pomerania. Stroke. 2005;36(5):938–43.CrossRefPubMed
29.
Skilton MR, Serusclat A, Begg LM, Moulin P, Bonnet F. Parity and carotid atherosclerosis in men and women: insights into the roles of childbearing and child-rearing. Stroke. 2009;40(4):1152–7.CrossRefPubMed
30.
Pries AR, Reglin B, Secomb TW. Remodeling of blood vessels: responses of diameter and wall thickness to hemodynamic and metabolic stimuli. Hypertension. 2005;46(4):725–31.CrossRefPubMed
31.
Herity NA, Ward MR, Lo S, Yeung AC. Review: clinical aspects of vascular remodeling. J Cardiovasc Electrophysiol. 1999;10(7):1016–24.CrossRefPubMed
32.
Kiechl S, Willeit J. The natural course of atherosclerosis. Part II: vascular remodeling. Bruneck Study Group. Arterioscler Thromb Vasc Biol. 1999;19(6):1491–8.CrossRefPubMed
33.
Abbas AE, Lester SJ, Connolly H. Pregnancy and the cardiovascular system. IntJCardiol. 2005;98(2):179–89.
34.
Bokov P, Chironi G, Orobinskaia L, Flaud P, Simon A. Carotid circumferential wall stress homeostasis in early remodeling: theoretical approach and clinical application. J Clin Ultrasound. 2012;40(8):486–94.CrossRefPubMed
35.
Toprak A, Kandavar R, Toprak D, Chen W, Srinivasan S, Xu JH, Anwar A, Berenson GS. C-reactive protein is an independent predictor for carotid artery intima-media thickness progression in asymptomatic younger adults (from the Bogalusa heart study). BMC Cardiovasc Disord. 2011;11:78.CrossRefPubMedPubMedCentral
36.
Ciccone MM, Scicchitano P, Zito A, Cortese F, Boninfante B, Falcone VA, Quaranta VN, Ventura VA, Zucano A, Di Serio F, et al. Correlation between inflammatory markers of atherosclerosis and carotid intima-media thickness in obstructive sleep apnea. Molecules. 2014;19(2):1651–62.CrossRefPubMed
37.
Ock SY, Cho KI, Kim HJ, Lee NY, Kim EJ, Kim NK, Lee WH, Yeo GE, Heo JJ, Han YJ, et al. The impacts of C-reactive protein and atrial fibrillation on carotid atherosclerosis and ischemic stroke in patients with suspected ischemic cerebrovascular disease: a single-center retrospective observational cohort study. Korean Circ J. 2013;43(12):796–803.CrossRefPubMedPubMedCentral
38.
Gallos ID, Sivakumar K, Kilby MD, Coomarasamy A, Thangaratinam S, Vatish M. Pre-eclampsia is associated with, and preceded by, hypertriglyceridaemia: a meta-analysis. BJOG. 2013;120(11):1321–32.CrossRefPubMed
39.
Mudd LM, Holzman CB, Catov JM, Senagore PK, Evans RW. Maternal lipids at mid-pregnancy and the risk of preterm delivery. Acta Obstet Gynecol Scand. 2012;91(6):726–35.CrossRefPubMedPubMedCentral
40.
Catov JM, Bodnar LM, Kip KE, Hubel C, Ness RB, Harger G, Roberts JM. Early pregnancy lipid concentrations and spontaneous preterm birth. Am J Obstet Gynecol. 2007;197(6):610 e611–7.CrossRef
Metadata
Title
Common carotid artery intima-media thickness increases throughout the pregnancy cycle: a prospective cohort study
Authors
Nancy Anderson Niemczyk
Marianne Bertolet
Janet M. Catov
Mansi Desai
Candace K. McClure
James M. Roberts
Akira Sekikawa
Ping Guo Tepper
Emma J. Barinas-Mitchell
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1841-y

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