First-trimester screening identifies maternal cardiac maladaptation in midgestation

Area of Science:

• Cardiovascular physiology in pregnancy
• Maternal health and hypertension
• Predictive modeling in obstetrics

Background:

• Chronic hypertension (CH) affects 70% of women within 3 years postpartum, predictable with a first-trimester model.
• Hypertensive disorders of pregnancy (HDP) are linked to persistent cardiovascular changes for over 2 years post-delivery.
• Early identification of cardiovascular maladaptation in pregnancy is crucial for managing maternal health risks.

Purpose of the Study:

• To evaluate if a first-trimester risk model for CH can identify women with midgestation cardiovascular maladaptation.
• To investigate the association between first-trimester CH risk and cardiovascular indices in midgestation.
• To explore the link between CH risk prediction and the development of hypertensive disorders of pregnancy (HDP).

Main Methods:

• Prospective observational study of 3812 pregnant women from December 2019 to August 2020.
• First-trimester assessment (11-13 weeks) included demographics, medical history, and blood pressure.
• Midgestation assessment (19-23 weeks) involved detailed maternal cardiovascular evaluation.

Main Results:

• High-risk women for future CH showed a higher incidence of HDP compared to low-risk women.
• Reduced systolic and diastolic cardiac function was observed in high-risk women during midgestation.
• Among women with HDP, those at high risk for future CH exhibited worse cardiac function in midgestation.

Conclusions:

• The first-trimester CH prediction model effectively identifies women with midgestation cardiac maladaptation.
• This model aids in recognizing individuals at higher risk for HDP and associated cardiovascular changes.
• Further research is needed to determine if these cardiac function deficits persist beyond pregnancy.