VEGFA and hydrops fetalis: Hypertension is the most commonly described CV adverse effect associated with VSPIs233,234 but these drugs are also associated with LVSD and HF.235 Meta-analysis of 21 trials including several VSPIs reported an incidence of LVSD of 2.4%.235 In addition to a fundamental role in the control of angiogenesis, VEGF signalling plays a pivotal role in endothelial cell proliferation and survival236 and acts as a compensatory mechanism in response to cardiac stressors.