Is conventional cardiac examination adequate for obese pregnant women? A prospective case-control study

Obesity in pregnancy shows short- and long-term adverse effects for both mother and baby. We aimed to investigate the effects of obesity on cardiac functions in the third trimester of pregnancy.

A prospective case-control study where the pregnant women at the third trimester of pregnancy were divided into two groups: obese (BMI≥30) and the controls (BMI<30). All participants underwent conventional 2D and speckle-tracking echocardiography, while structural and functional cardiac parameters were measured. The unpaired t-test or the Mann-Whitney-U test were used to compare values between the two groups. p ≤ 0.05 was outlined to be statistically significant.

Forty-one obese pregnant women and 41 healthy and normal-weight pregnant controls were recruited. The mean BMI was 24.6 ± 2.4 kg/m² in the controls and 38.5 ± 5.4 kg/m² in the obese group. SV was significantly higher in obese patients (p = 0.02). SVI was markedly lower in the obese group (p < 0.01). CO and Cardiac Index were significantly higher in obese patients compared to the controls (p < 0.01). TVRI was significantly higher in the obese group than the controls. EF was similar between the two groups (p = 0.33). LVM and LVMI were significantly higher in obese patients than the controls (p = 0.024 and p = 0.01). Diastolic dysfunction was present in 3 (7.3%) controls; 21 (51.2%) of the obese women demonstrated diastolic dysfunction, and it was significantly higher than the controls (p < 0.01). LV-GLS and LV-GCS were substantially lower in the obese group (p < 0.01). RV-FAC and RV-GS were markedly lower in the obese group (p < 0.01). TAPSE was similar in obese and control groups (p = 00.17).

Obesity in pregnancy is associated with increased subclinical systolic and diastolic dysfunction, which cannot be detected by standard 2D methods.