Deteção Precoce no Sangue do Cordão Umbilical de Biomarcadores de Alterações da Função Cardíaca Identificadas Precocemente na Descendência de Mães com Fatores de Risco

Abstract

Arterial hypertension, diabetes and obesity are risk factors during pregnancy and can have significant effects on the development of the fetus, including the cardiovascular system. The "fetal programming window" refers to the critical period in fetal development when environmental and nutritional factors can influence the programming of many body systems. During this time, the cardiovascular system is being formed, and if there are negative influences, there can be an impact on future cardiovascular health. Risk factors such as gestational diabetes, hypertension and obesity during pregnancy can negatively affect the cardiovascular health of the fetus during the fetal programming window. In addition, these factors can increase the production of toxic substances to the development of the cardiovascular system, increasing the risk of developing future cardiovascular diseases. The pathophysiological mechanism that involves cardiac remodeling in the fetal phase includes intrauterine exposure to the hyperinsulinemic environment, free radicals due to oxidative stress, and volumetric overload, which leads to increased cardiac size, ventricular wall hypertrophy and cardiac dysfunction. These changes can have long-term consequences on the cardiovascular health of the fetus. Although it is not clear from the current literature, ventricular abnormalities early in life may predispose these children to develop overt cardiac dysfunction as adults, or as other cardiovascular risk factors emerge. Early postnatal life may represent a critical window for cardiac development, and optimizing perinatal care may reduce long-term cardiovascular sequelae. Thus, primary prevention to reduce the prevalence of obesity, diabetes and uncontrolled hypertension in pregnant women of reproductive age, early echocardiographic evaluation and identification of circulating plasma markers are essential to reduce the risks and evolution of cardiovascular changes. The objective of this study is to identify potential circulating cardiovascular biomarkers in umbilical cord blood collected at the time of delivery and relate it to the assessment of cardiac function through echocardiographic analysis of the babies whose blood was analyzed. To carry out this study, the following phases will be briefly described: 1. Recruitment of pregnant women at the time of induction of labor in the obstetrics ward of Centro Hospital Universitário de São João; 2. Human Umbilical Cord Blood Collection (HUCB) and sample processing at the Department of Physiology and Cardiothoracic Surgery at the Faculty of Medicine of the University of Porto; 3. Quantification of circulating plasma markers capable of identifying potential markers of cardiac dysfunction in offspring (NT-proBNP, ST-2, C-reactive protein and cTnT, aldosterone and renin, tissue inhibitor of matrix metalloproteinases-1, pro-collagen proteinase of the carboxyterminal, lysyl oxidase and metalloproteinases (MMP1 and MMP9); 4. After birth, a pediatric cardiological assessment will be performed using transthoracic echocardiography at the Department of Physiology and Cardiothoracic Surgery at the Faculty of Medicine of Porto, following the protocol for cardiac assessment in paediatrics. At the same time, data on pregnancy, childbirth and puerperium will be collected, and obtained through the pregnant and child's bulletins. 5. Statistical analysis and writing of a scientific article and thesis.