Longitudinal maternal hemodynamics in high-risk pregnancies with different subtypes of pre-eclampsia

To evaluate maternal cardiac adaptation during pregnancy by comparing longitudinal hemodynamic profiles between women identified as high risk for preterm pre-eclampsia (PE) who subsequently developed preterm PE, term PE or remained unaffected, as well as low-risk women.

This was a prospective longitudinal study of 1078 Chinese women with a singleton pregnancy who were enrolled in a first-trimester screen-and-prevent program for preterm PE at the Prince of Wales Hospital, Hong Kong SAR, China, between January 2020 and June 2024. Participants were classified as high or low risk for preterm PE based on the Fetal Medicine Foundation first-trimester combined test. Participants were followed up at 12 + 0 to 15 + 6 weeks' gestation, 20 + 0 to 24 + 6 weeks and 30 + 0 to 37 + 6 weeks to measure hemodynamic variables, including heart rate (HR), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR) and mean arterial pressure (MAP). Participants were categorized into four groups according to risk status for preterm PE and subsequent development of PE: low risk who did not develop PE (Group 1, n = 407); high risk who did not develop PE (Group 2, n = 598); high risk who developed term PE (Group 3, n = 29); and high risk who developed preterm PE (Group 4, n = 44). Hemodynamic variables were log₁₀ transformed and analyzed using linear mixed-effects models, adjusting for maternal characteristics and clinical visits. Estimated marginal means of log₁₀-transformed values for hemodynamic variables were compared between the groups throughout pregnancy and at each clinical visit.

Compared with Group 1, all high-risk groups exhibited lower SV and CO and higher SVR and MAP throughout pregnancy (all P < 0.05), while HR was significantly elevated in Group 2 (P < 0.001). Compared with Group 2, Group 4 had lower HR, SV and CO and higher SVR and MAP throughout pregnancy (all P < 0.01). In contrast, Group 3 showed no significant differences in HR, SV, CO and SVR compared with Group 2 (all P > 0.05), although there was an increase in MAP from midgestation onwards (P < 0.001). Compared with Group 3, Group 4 exhibited lower CO and higher SVR and MAP throughout pregnancy (all P < 0.05).

Compared with low-risk women who do not develop PE, high-risk women with or without preterm or term PE exhibit distinct cardiac maladaptation profiles from early to late gestation. These findings offer insight into the different pathophysiological mechanisms underlying PE subtypes and should inform risk stratification. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.