Maternal vascular status and BMI-associated phenotyping is instrumental for predictive, preventive and personalised approach in healthy pregnancy

Abstract Cardiovascular disease remains the leading cause of disease burden globally with far-reaching consequences including enormous socio-economic burden to healthcare and society at large. Cardiovascular health is decisive for reproductive function, healthy pregnancy and post-partum. During pregnancy, maternal cardio-vascular system is exposed to highly increased haemodynamic stress that significantly impacts health status of the mother and offspring. Resulting from sub-optimal maternal health conditions overlooked in pre-pregnancy time, progressive abnormalities can be expected during pregnancy and post-partum. Contextually, there are two main concepts to follow in the framework of 3P medicine, namely to develop 1. advanced screening of sub-optimal health in young populations to predict and prevent individual health risks prior to planned pregnancies2. in-depth companion diagnostics during pregnancy to predict and prevent long-lasting post-partum health risks of the mother and offspring. Data collected in the current study demonstrate group-specific complications in the mother and offspring and clinical relevance of BMI-related phenotyping in pre-pregnant mothers. Diagnostic approach proposed in this study revealed great clinical utility demonstrating important synergies between cardiovascular maladaptation and connective tissue dysfunction. Co-diagnosed pre-pregnancy low BMI of the mother, connective tissue dysfunction, increased stiffness of peripheral vessels and decreased blood pressure is considered a highly specific maternal phenotype useful for innovative screening programmes in young populations to predict and prevent severe risks to health of the mother and offspring. This crucial discovery brings together systemic effects characteristic, for example, for individuals with Flammer syndrome predisposed to the phenotype specific primary vascular dysregulation, pregnancy-associated risks, normal tension glaucoma, ischemic stroke at young age, impaired wound healing and associated disorders. Proposed maternal phenotyping is instrumental to predict individual maternal health risks associated with pregnancy and to protect both the mother and offspring against potential complications. Corresponding innovation applied to screening programmes focused on sub-optimal health in young populations and utilising here described phenotypes is pivotal for advanced health policy.