PhD defence C.J. (Clarissa) Wiertsema

Dissertation in short:

From early-pregnancy onwards, impaired maternal cardiovascular health may result in impaired uteroplacental circulation, elevated blood pressure levels and the development of gestational hypertensive disorders. Although gestational hypertensive disorders clinically manifest in later stages of pregnancy, the origin of this spectrum of disorders is assumed to be found in early-pregnancy. A healthy maternal diet has been recognized to benefit maternal cardiovascular health. Improvements in maternal diet prior to and during early-pregnancy might also facilitate adequate hemodynamic responses to pregnancy that lead to a lower risk of gestational hypertensive disorders. Women who suffered from any gestational hypertensive disorder are at increased risk of developing cardiovascular disease far beyond pregnancy. Likewise, the offspring of pregnancies affected by gestational hypertensive disorders may have long-term cardiovascular health consequences. Identifying pregnant women and children that are at risk from early-pregnancy onwards of adverse cardiovascular consequences, may help to develop strategies at earlier stages in life to prevent adverse cardiovascular health in later life. Specific focus to identify critical periods for adverse exposures and potential underlying mechanisms for adverse outcomes, might further aid in appropriate timing and specific targets for these preventive strategies. Novel markers on first-trimester fetal development may further help to elucidate mechanisms of fetal developmental adaptations in earlypregnancy that may result in adverse cardiovascular health in later life. The general aim of this thesis was to assess dietary factors that might influence maternal cardiovascular health during pregnancy, the influence of gestational hypertensive disorders and pre- and postnatal growth on offspring cardiovascular health, and to develop novel measurements of first-trimester fetal development. The studies presented in this thesis were embedded in the Generation R and Generation R Next studies. The Generation R Study is a population-based prospective cohort study from early-pregnancy onwards in Rotterdam,
The Netherlands. The Generation R Next Study is population-based prospective cohort study with study enrollment from the preconception phase onwards. These studies were
designed to identify early environmental and genetic determinants of growth, development and health in preconception, pregnancy and beyond focusing on both mother and child.