Cardiovascular risk assessment in women at high risk for pre-eclampsia in first half of pregnancy

Women diagnosed with pre-eclampsia (PE), especially those with early-onset and severe forms, are at heightened risk of future cardiovascular disease. However, it is uncertain if women at high risk for PE present cardiovascular impairment at the beginning of pregnancy. The aim of this study was to assess cardiovascular biomarkers and cardiac function in the first half of pregnancy in women at high risk for PE.

This was a prospective cohort study including women attending first-trimester screening for PE at a single center in Spain, between July 2020 and April 2023. The risk of PE in the first trimester was calculated using a previously validated model that includes maternal factors and biophysical markers. A cut-off of 1 in 250 was used to classify high risk for developing PE. Maternal echocardiographic function and morphometry were evaluated, and peripheral blood samples were obtained to assess hematological and biochemical variables, including lipid profile and cardiovascular and angiogenic factors. Findings were compared between women at high risk and those at low risk for PE.

A total of 349 pregnant individuals were included, 257 at high risk and 92 at low risk for PE. Maternal echocardiography was performed at a mean ± SD gestational age of 14.9 ± 1.3 weeks and blood sampling at 16.3 ± 1.9 weeks. The high-risk PE group exhibited a worse lipid profile (significantly lower levels of high-density lipoprotein (69.7 ± 14.2 vs 74.0 ± 14.6 mg/dL; P = 0.020), significantly lower placental growth factor multiples of the median (0.89 ± 0.63 vs 1.15 ± 0.58; P < 0.001) and significantly lower levels of N-terminal pro B-type natriuretic peptide (51.0 ± 2.1 vs 52.1 ± 2.0 ng/L; P = 0.008)). Echocardiographic evaluation indicated concentric remodeling along with an altered diastolic pattern in the high-risk group.

Women at high risk of developing PE exhibit differences in lipid profile, angiogenic factors and echocardiographic parameters, indicative of cardiac maladaptation or impairment during the first half of pregnancy. These findings suggest a link between subclinical cardiovascular dysfunction, PE development and later cardiovascular disease risk. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.