Effect of Prematurity and hypertensive disorders of pregnancy on Offspring Cardiovascular Health (EPOCH) Study

Study Background

A focus of our research is to explore cardiovascular development in relation to birth history. There is growing evidence to suggest that complications in pregnancy, such as a premature birth or maternal high blood pressure, have an effect on the cardiovascular system of the offspring. For example, babies born to either of these two complications seem to have higher blood pressure in later life compared to their peers. However, it is not clear how or why this happens.

Our recent findings from the Early Vascular Study, which recruited young adults in their mid-20’s who were born prematurely (delivered before 37 weeks gestation), suggest that preterm birth is associated with the development of a unique cardiovascular system. We found differences in the structure and function of the heart and blood vessels, with an additional effect on heart function if the premature baby had been exposed to a maternal condition called pre-eclampsia (high blood pressure and protein in the urine) in the womb.

Whether the differences we observed are present prior to, or soon after birth, is unknown.  We also do not know how preterm birth and exposure to maternal high blood pressure in the womb interact to have an effect on the cardiovascular system of the offspring.

Study Objective

The purpose of the EPOCH study is to help understand more about how the development of the cardiovascular system is influenced by our birth history.  We specifically wish to understand the effect of premature birth and exposure to maternal high blood pressure on the heart and blood vessels around the time of birth and in the first few months of life.

Using the results from the EPOCH study, we hope to understand more about how to manage and prevent heart disease risk later in life in babies that have been exposed to these complications during pregnancy.

Study Recruitment

We recruited over 200 mothers and babies who had pregnancies complicated by either a preterm birth and/or maternal high blood pressure. We also recruited about 50 women who had uncomplicated pregnancies to use as comparison.

We invited participation from mothers attending the antenatal services or being admitted to the antenatal wards in the John Radcliffe Hospital, Oxford University Hospitals Trust.

Study Visits

There will be three study visits which will all take place at the John Radcliffe Hospital. The first (Visit 0) would take place in the weeks before the baby is born and involves an ultrasound scan of the baby’s heart.

After the baby is born, two identical assessments will take place in the week after birth (Visit 1) usually whilst the mother and baby are still in hospital, and when the baby is three months old (Visit 2). These two visits involve detailed tests on the structure and function of the cardiovascular system of the baby. All of our tests are non-invasive, do not involve any radiation and should not be distressing for the baby. They include an ultrasound of the heart (echocardiogram), a recording of the heart’s electrical activity (electrocardiogram) and imaging of the small blood vessels (capillaries) under the baby’s arm. We also take a small sample of blood from the mother.

Visit 0 should take no longer than 30 minutes. Visit 1 and 2 take approximately 45 minutes and scheduled at the participant’s convenience with the option of splitting Visit 1  into two 20 minute assessments.  Full details of the study visits will be explained to potential participants in the study information leaflets.

Research Funding

The study is supported with funding from the British Heart Foundation.

Study Approval

The study has been approved by the South Central Berkshire Research Ethics Committee (Reference 11/SC/0006)