First trimester screening identifies maternal cardiac maladaptation at mid‐gestation

Background

First, a logistic regression model, based on maternal demographic characteristics and medical history and blood pressure at 11‐13 weeks’ gestation, can identify about 70% of women who develop future chronic hypertension (CH) in the three years following pregnancy, at screen positive rate of 10%. Second, at mid‐gestation women who subsequently develop hypertensive disorders of pregnancy (HDP) have increased peripheral vascular resistance and mild cardiac functional and morphological alterations and these cardiovascular abnormalities persist for at least 2 years after delivery.

Objective

To examine whether the use of the first‐trimester risk for subsequent development of CH can help to identify women at high risk for cardiovascular maladaptation at mid‐gestation.

Methods

Prospective observational study in 3812 women with singleton pregnancies women attending for a routine hospital visit at 11+0 to 13+6 weeks’ gestation and again at 19+1 to 23+3 weeks at King's College Hospital, London, UK between August 2019 and August 2020. The first‐trimester visit included recording of maternal demographic characteristics and medical history and measurement of systolic and diastolic blood pressure. At mid‐gestation detailed maternal cardiovascular assessment was carried out. The association of risk for development of CH, determined from first‐trimester assessment, and cardiovascular indices at mid‐gestation was examined.

Results

Women who are at high‐risk for development of future CH, compared to those at low‐risk, had a higher incidence of hypertensive disorders of pregnancy (HDP). In addition, high‐risk women, had reduced systolic and diastolic function at mid‐gestation. Among women with HDP, those who were high‐risk for future CH, compared to those at low‐risk, also had worse cardiac function at mid‐gestation.

Conclusion

Use of a model for first‐trimester prediction of subsequent development of CH can identify women who show evidence of cardiac maladaptation at mid‐gestation. Further studies are needed to clarify whether women who screen as high‐risk for future CH, compared to those at low‐risk, have reduced cardiac function beyond pregnancy.

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