MRI assessed cardiac structure and function in young adult offspring of hypertensive pregnancies: a 27-year prospective follow-up birth cohort.

Echocardiographic studies have demonstrated cardiac changes in offspring of individuals with hypertension during pregnancy. Cardiovascular magnetic resonance (CMR) imaging is the gold standard for assessing cardiac structure and function. We investigated whether hypertensive pregnancies were associated with differences in CMR parameters in offspring. Offspring of women enrolled during pregnancy in the Raine Study underwent CMR at age 27 years. CMR was analyzed by blinded investigators. Offspring were stratified according to whether they were born to hypertensive (HTN) pregnancies versus normotensive pregnancies. Subgroup analysis was performed comparing the offspring of pregnancy with complicated HTN (proteinuria or preterm delivery) versus pregnancy with uncomplicated HTN. Separate analyses were conducted by sex. Multivariate linear regression analyses were performed. 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 versus normotensive pregnancy in male (131.9 ± 11.1 vs. 128.8 ± 11.9 mmHg, P = 0.015) and female offspring (118 ± 10.3 vs. 115.4 ± 11 mmHg, P = 0.037). There were no significant differences in left ventricular mass index (LVMI), left ventricular global longitudinal strain, and left atrial reservoir strain between normotensive versus HTN pregnancies in male (55.0 ± 7.4 vs. 56.7 ± 7.9 g/m2, 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 ± 5.6 g/m2, 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 ± 5.8 g/m2, P = 0.010). In the largest prospective CMR study, hypertensive pregnancy was not associated with adverse changes in cardiac structure and function in young adult offspring.NEW & NOTEWORTHY This study is the largest prospective cardiac magnetic resonance study to assess clinical and subclinical changes in young adult offspring of hypertensive pregnancy. No significant adverse changes in cardiac structure and function were observed. The link between hypertension during pregnancy and future cardiovascular risk in the offspring is likely to be multifactorial and may not necessarily manifest as findings on cardiac magnetic resonance imaging in young adulthood.