Prenatal exposure to isolated amniotic fluid disorders and the risk for long-term cardiovascular morbidity in the offspring

Abstract

Amniotic fluid (AF) abnormalities are often associated with short-term adverse pregnancy outcomes, including cardiovascular-related. We sought to assess whether in utero exposure to AF abnormalities increases the risk for long-term cardiovascular morbidity of the offspring. We examined the incidence of cardiovascular disorders in singletons exposed and non-exposed to isolated oligohydramnios or polyhydramnios. Cardiovascular morbidity was assessed up to the age of 18 years according to a predefined set of ICD-9 codes. A Kaplan–Meier survival curves were used to compare cumulative morbidity incidence. A Cox proportional hazards model was constructed to control for confounders. During the study period, 195,943 newborns met the inclusion criteria, of which 2.0% (n = 4063) were in pregnancies diagnosed with isolated oligohydramnios and 2.9% (n = 5684) in pregnancies with isolated polyhydramnios. Children exposed to isolated AF disorders had significantly higher rates of long-term cardiovascular morbidity (p=.042). Children exposed to isolated oligohydramnios had higher cumulative incidence of cardiovascular morbidity (log-rank test p=.026) compared to unexposed children, opposing to what was demonstrate when comparing polyhydramnios vs. normal AFV (log-rank test p=.749). In the Cox regression model, while controlling for confounders, isolated oligohydramnios were found to be independently associated with long-term cardiovascular morbidity of the offspring.

Chinese abstract

羊水(AF)异常通常与短期不良妊娠结局相关, 包括心血管相关的妊娠结局。为了评估子宫内暴露于AF异常是否会增加子代长期心血管疾病的风险。我们研究了单独暴露于羊水过少或羊水过多和未暴露的单胎子女心血管疾病的发生率。根据一组预定义的ICD-9代码评估心血管疾病的发病率至18岁。采用Kaplan-Meier生存曲线比较累积发病率。为控制混杂因素, 构建了Cox比例风险模型。在研究期间, 195943名新生儿符合纳入标准, 其中2.0%(n=4063)的新生儿被诊断为羊水过少, 2.9%(n=5684)的新生儿被诊断为羊水过多。暴露于孤立性羊水疾病的儿童有更高的长期心血管疾病发病率（p=.042）。与未暴露的儿童相比, 暴露于孤立羊水过少的儿童具有更高的心血管疾病的累积发生率(log-rank检验p=0.026), 这与羊水过多与正常AFV的对比结果相反(log-rank检验p=0.749)。在Cox回归模型中, 在控制混杂因素的同时, 发现孤立的羊水过少与子代的长期心血管发病率独立相关。

Keywords:

• Long term cardiovascular morbidity
• polyhydramnios
• oligohydramnios

Acknowledgements

This study was conducted as part of the requirements for MD degree from the Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev.

Disclosure statement

We declare that we have no conflict of interest.