The purpose of this study is to understand more about why women who have had hypertensive pregnancies may be at increased risk of high blood pressure and why these women are often at increased risk of heart and blood vessel disease later in life.
Women who experience high blood pressure during pregnancy are at increased risk of developing cardiac and vascular diseases later in life. They show changes in their heart, brain, and blood vessels long before they develop high blood pressure. The investigators therefore think that these changes develop slowly over the course of the life of the woman and establish their risk of later disease. Through better understanding of the pattern of changes across multiple parts of the body over extended periods of time, the investigators aim to identify how advanced the underlying disease is for an individual and how the disease is likely to develop over the next few years. By comparing the rate of change across different parts of the body, the investigators can examine how one area affects another. Data including images of the heart, brain and blood vessels will be acquired in women 10 to 25 years after their pregnancy. The initial analysis will focus on assessing differences between women who have had a normotensive pregnancy and those who have had a hypertensive pregnancy, both at a single timepoint and in changes within individuals over time. This dataset will then be used in conjunction with previously acquired data in women who have experienced a hypertensive pregnancy to find out how patterns emerge across the whole body. The investigators will subsequently combine information from different measures at the same time and use the machine learning models to learn the patterns of change that occur as a person progresses from a healthy to a diseased state. This will allow the researchers to identify patterns of hypertensive disease development and it may open doors to better interventions and therapies tailored towards individuals.
Study Type
OBSERVATIONAL
Enrollment
200
Participants will attend one visit lasting approximately 3-4 hours on a single day or split over multiple visits to complete all measures. Participants will first be asked to provide written informed consent for the study. Participants' anthropometric measures (waist-to-hip ratio, height and weight, hip and waist circumference and left arm circumference and resting blood pressures will then be taken. After this, the participants will undergo cardiopulmonary exercise testing, followed by magnetic resonance imaging, echocardiography, retinal imaging and vascular imaging of the ear. The study visit will conclude with participants being provided with a wrist-worn physical activity monitor to wear for 7-9 days following the visit. These monitors will provide objective measures of physical activity while people go about their normal activities.
University of Oxford Department of Cardiovascular Medicine
Oxford, United Kingdom
RECRUITINGCardiac right ventricular mass
Magnetic resonance imaging assessment of cardiac right ventricular mass indexed to body surface area (g/m\^2).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy. Index pregnancy is defined as the pregnancy which we first collected data from.
Cardiac left ventricular mass
Magnetic resonance imaging assessment of cardiac left ventricular mass indexed to body surface area (g/m\^2).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac right ventricular end-diastolic volume
Magnetic resonance imaging assessment of cardiac right ventricular end-diastolic volume indexed to body surface area (ml/m\^2)
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac right ventricular stroke volume.
Magnetic resonance imaging assessment of cardiac right ventricular stroke volume indexed to body surface area (ml/m\^2).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac left-ventricular end-diastolic volume.
Magnetic resonance imaging assessment of cardiac left ventricular end-diastolic volume indexed to body surface area (ml/m\^2).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac left ventricular stroke volume
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Magnetic resonance imaging assessment of cardiac left ventricular stroke volume indexed to body surface area (ml/m\^2).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac right ventricular systolic function
Echocardiography assessment of right ventricular systolic function: tricuspid annular plane systolic excursion (cm).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac right ventricular ejection fraction
Magnetic resonance imaging assessment of right ventricular ejection fraction measured by cardiac magnetic resonance imaging (%).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac left ventricular systolic function
Echocardiography assessment of left ventricular systolic function
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac left ventricular ejection fraction
Magnetic resonance imaging assessment of left ventricular ejection fraction (%).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac right ventricular diastolic function
Echocardiography assessment of right ventricular doppler early/late diastolic tricuspid inflow velocity ratio (E/A)
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac left ventricular diastolic function
Echocardiography assessment of left ventricular doppler early/late diastolic mitral inflow velocity ratio (E/A).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cardiac left ventricular diastolic function
Echocardiography assessment of left ventricular early doppler inflow velocity/peak early diastolic tissue velocity rate (E/e').
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Morphology of the right ventricles
Magnetic resonance imaging assessment of the right ventricles morphology using cardiac statistical atlas and principal component analysis.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Morphology of the left ventricles
Magnetic resonance imaging assessment of the left ventricles morphology using cardiac statistical atlas and principal component analysis.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Aortic distensibility
Aortic distensibility by magnetic resonance imaging (10\^-3 mmHg-1).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Aortic compliance
Aortic/central blood pressure by cuff measurement (mmHg).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Intra-hepatic liquid content and steatohepatitis
Magnetic resonance imaging assessment of the liver to quantify proton density fat fraction (%).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Hepatic fibrosis
Magnetic resonance imaging assessment of the liver to quantify fibro-inflammatory status from iron corrected T1 (cT1 in ms)
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Renal volumes
Magnetic resonance imaging assessment of renal volumes (ml/m\^2).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Renal fibro-inflammatory status
Magnetic resonance imaging assessment of fibro-inflammatory status from T1 (ms)
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Renal blood perfusion
Magnetic resonance imaging assessment of surrogate measures of blood perfusion from T2\* (in ms).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Oxygen uptake across submaximal exercise
Cardiopulmonary exercise test to measure oxygen uptake (ml/kg/min).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Carbon dioxide exchange kinetics across submaximal exercise
Cardiopulmonary exercise test to measure respiratory exchange ratio (RER) calculated as carbon dioxide production divided by oxygen consumption.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Retinal arteriolar structure
Central retinal arteriolar equivalent (CRAE) in micrometres measured using retinal imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Retinal venular structure
Central retinal venular equivalent (micrometres) measured using retinal imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Retinal arteriolar-to venule diameter ratio (AVR)
The ratio of average retinal arteriolar diameter and average retinal venous diameter (micrometres).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Ear microvascular structure.
Superior crus of anti-helix earlobe vascular calibre (micrometres) measured using ear vascular imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Lung function
The ratio of FEV1 to FVC (FEV1/FVC) measured using spirometry.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Lung capacity
The forced vital capacity (FVC in L) measured using spirometry.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Lung volume
The forced expiratory volume in one second (FEV1 in L) measured using spirometry.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Objective measure of vigorous physical activity.
The amount of vigorous physical activity (h/week) measured using wrist worn accelerometer.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Objective measure of moderate to vigorous physical activity.
The amount of moderate to vigorous physical activity (h/week) measured using wrist worn accelerometer.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Total white matter volume
Total white matter volumes (mm3) assessed on T1-weighted sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Total grey matter volume
Total grey matter volumes (mm3) assessed on T1-weighted sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Subcortical brain volume of thalamus
Subcortical brain volume of thalamus (mm3) assessed on T1-weighted sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Subcortical brain volume of hippocampus
Subcortical brain volume of hippocampus (mm3) assessed on T1-weighted sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
White matter hyperintensities volume
Total volume of white matter hyperintensities (mm3) assessed on T2-weighted sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
White matter hyperintensities count
Total number of white matter hyperintensities on T2-weighted sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cerebral vessel lumen diameter
Cerebral vessel lumen diameter (micrometres) assessed on the time-of-flight sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cerebral vessel tortuosity
The ratio of cerebral vessel tortuosity assessed on the time-of-flight sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Cerebral vessel density
Cerebral vessel density (mm3) assessed on the time-of-flight sequence of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Whole brain grey matter perfusion or cerebral blood flow (CBF)
Whole brain grey matter perfusion/CBF (in ml/100g/min) assessed on arterial spin labelling of brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Arterial cerebral blood volume fraction
Arterial cerebral blood volume fraction (%) assessed on arterial spin labelling on brain magnetic resonance imaging.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating vascular endothelial growth factor A as an angiogenic marker
The level of circulating vascular endothelial growth factor A (pg/mL) measured from plasma blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating soluble endoglin as an angiogenic marker.
The level of circulating soluble endoglin (ng/mL) measured from plasma blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating soluble fms-like tyrosine kinase-1 as an angiogenic marker.
The level of circulating soluble fms-like tyrosine kinase-1 measured from plasma blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating total cholesterol as a metabolic marker
The level of total cholesterol (mmol/L) measured from serum blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating high-density lipoprotein as a metabolic marker
The level of circulating high-density lipoprotein (mmol/L) measured from serum blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating low-density lipoprotein as a metabolic marker
The level of circulating low-density lipoprotein (mmol/L) measured from serum blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating triglycerides as a metabolic marker
The level of circulating triglycerides (mmol/L) measured from serum blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating fasting glucose concentration as a metabolic marker
The level of fasting glucose (mmol/L) measured from whole blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating fasting insulin concentration as a metabolic marker
The level of fasting insulin (pmol/L) measured from serum blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Insulin resistance index as a metabolic marker
The index calculated as fasting glucose (mmol/L) x fasting insulin (ulU/mL)/22.5.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating C-reactive protein as an inflammatory marker.
The level of circulating C-reactive protein (mmol/L) measured from serum blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating soluble intercellular adhesion molecule-1 (slCAM-1) as an inflammatory marker
The level of sICAM-1 (ng/mL) measured from serum blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Circulating soluble vascular adhesion molecule-1 (sVCAM-1) as an inflammatory marker
The level of sVCAM-1 (ng/mL) measured from serum blood samples.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Body weight
Body weight (kg)
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Body height
Body height (m).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Body mass index (BMI)
Body weight divided by the square of height (kg/m2).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Mid-arm circumference
Mid-arm circumference (cm).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Waist-to-hip ratio
The ratio of waist circumference (cm) to hip circumference (cm).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Systolic blood pressure
Resting brachial blood pressure measurement (mmHg).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Diastolic blood pressure
Resting brachial blood pressure measurement (mmHg).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Mean arterial pressure.
The average arterial pressure from resting brachial blood pressure measurement (mmHg).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Pulse pressure
The difference between systolic and diastolic blood pressure (mmHg).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Heart rate
The frequency of the heart contractions per minute (bpm).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Smoking status
The number and percentage of current smokers.
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy
Alcohol consumption
Weekly alcoholic unit intake (units per week).
Time frame: Participants will be recruited at 10 to 25 years post index pregnancy and assessed up to 40 years post index pregnancy