What is the clinical evidence from this study?

Study design: Cohort. Population: Early-onset severe preeclampsia (n=1484). Intervention: Early-onset severe preeclampsia vs. Pregnant patients without hypertensive disorders of pregnancy. Primary outcome: New-onset maternal arrhythmia (OR 2.68, 95% CI 1.53-4.70, p=<0.001).

What question did this study set out to answer?

This study aims to determine if early-onset severe preeclampsia increases the risk of new-onset maternal arrhythmia during and after pregnancy.

April 25, 2026Open Access

Early-Onset Severe Preeclampsia as an Independent Predictor of New-Onset Maternal Arrhythmia During Pregnancy: A Retrospective Cohort Study

Q: What are the key findings of this study?

Early-onset severe preeclampsia independently increased the odds of new-onset maternal arrhythmia by 2.68-fold compared to pregnancies without hypertensive disorders.

Q: What does this research mean for the field?

Early-onset severe preeclampsia independently increases the odds of new-onset maternal arrhythmia by 2.68-fold compared to pregnancies without hypertensive disorders. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This study aims to determine if early-onset severe preeclampsia increases the risk of new-onset maternal arrhythmia during and after pregnancy.

Key Result

Early-onset severe preeclampsia independently increased the odds of new-onset maternal arrhythmia by 2.68-fold compared to pregnancies without hypertensive disorders.

Key Points

This study aims to determine if early-onset severe preeclampsia increases the risk of new-onset maternal arrhythmia during and after pregnancy.
Retrospective cohort study utilizing the TriNetX database from 2015 to 2024, involving 742 EOSPE patients matched with controls.
Inclusion criteria included pregnant individuals aged 18 to 45; exclusion criteria involved prior arrhythmia or structural heart disease.
Statistical analyses included conditional logistic regression and Cox proportional hazards modeling.
New-onset maternal arrhythmia occurred in 6.2% of EOSPE patients versus 2.4% of controls (absolute risk difference 3.8%).
EOSPE was associated with increased odds of arrhythmia (odds ratio 2.68, 95% CI 1.53 to 4.70; p < 0.001).
Time-to-event analysis indicated a higher hazard of arrhythmia (hazard ratio 2.41, 95% CI 1.38 to 4.20; log-rank p < 0.001).

Study Design

Type

Cohort (n=1,484)

Multicenter

Yes

Structured PICO

Does early-onset severe preeclampsia increase the risk of new-onset maternal arrhythmia in pregnant individuals?

Population

1,484 pregnant individuals aged 18 to 45 years (742 with early-onset severe preeclampsia matched 1:1 with 742 controls). Excluded: prior arrhythmia, structural heart disease, cardiomyopathy, ischemic heart disease, inherited arrhythmia syndromes, clinically significant valvular heart disease, prior cardiac surgery, prior myocardial infarction, multiple gestation, advanced CKD (eGFR <30), type 1 DM with end-organ complications, and substance use disorder other than tobacco.

Intervention

Early-onset severe preeclampsia (EOSPE), defined as preeclampsia with severe features occurring before 34 weeks of gestation.

Comparator

Pregnant patients without hypertensive disorders of pregnancy during the index pregnancy, matched 1:1 using propensity score matching.

Outcome

New-onset maternal arrhythmia (composite of supraventricular tachycardia, atrial fibrillation or flutter, ventricular arrhythmias, clinically significant ectopy, or conduction disorders) occurring during pregnancy or within six weeks postpartum.composite

Early-onset severe preeclampsia is independently associated with a 2.5- to 2.7-fold increased risk of new-onset maternal arrhythmia during pregnancy and the early postpartum period, highlighting the need for closer cardiovascular monitoring in this high-risk population.

Main Result

Effect estimate: OR 2.68 (95% CI 1.53-4.70)

Absolute Event Rate: 6.2% vs 2.4%

p-value: p=<0.001

Limitations

Dependence on the accuracy of ICD-10 coding and potential underdiagnosis of asymptomatic arrhythmias
Potential unmeasured confounding from genetic predisposition or dietary factors
Lack of raw ECG tracings to confirm diagnoses or characterize arrhythmia burden
Predominantly United States healthcare systems, limiting generalizability to other settings
Exclusion criteria limit generalizability to the healthiest subset of EOSPE patients
Small number of ventricular arrhythmia events resulted in imprecise effect estimates
Lack of data on preeclampsia treatments such as magnesium sulfate or labetalol
Potential healthy survivor bias
Lack of granular data on arrhythmia timing relative to delivery and medications
No systematic follow-up beyond six weeks postpartum

Abstract

Background Early-onset severe preeclampsia (EOSPE) is characterized by marked vascular injury, systemic inflammation, and acute hemodynamic stress. However, its independent association with newly occurring maternal arrhythmias during pregnancy has not been well established. Objective To evaluate whether EOSPE independently increases the risk of new-onset maternal arrhythmia using propensity score matching. Methods We conducted a retrospective cohort study using the TriNetX database from 2015 to 2024. Pregnant individuals aged 18 to 45 years were included. EOSPE was defined as preeclampsia with severe features occurring before 34 weeks of gestation according to American College of Obstetricians and Gynecologists criteria. The primary outcome was new-onset maternal arrhythmia, including supraventricular tachycardia, atrial fibrillation or flutter, ventricular arrhythmias, clinically significant ectopy, or conduction disorders occurring during pregnancy or within six weeks postpartum. Patients with prior arrhythmia or structural heart disease were excluded. After applying inclusion and exclusion criteria, 742 EOSPE patients were matched 1:1 with controls without hypertensive disorders of pregnancy. Matching variables included age, race, body mass index, chronic hypertension, diabetes mellitus, chronic kidney disease, obesity, tobacco use, and prior adverse pregnancy history. Statistical analyses included conditional logistic regression, multivariable adjustment, Cox proportional hazards modeling, and subgroup interaction testing. Results Following matching, baseline characteristics were well balanced with standardized mean differences below 0.08. New-onset maternal arrhythmia occurred in 6.2% (46/742) of EOSPE patients compared with 2.4% (18/742) of controls, corresponding to an absolute risk difference of 3.8%. EOSPE was associated with increased odds of arrhythmia (odds ratio 2.68, 95% confidence interval 1.53 to 4.70; p < 0.001), which remained significant after adjustment (adjusted odds ratio 2.49, 95% confidence interval 1.39 to 4.45; p = 0.002). Time-to-event analysis demonstrated a higher hazard of arrhythmia (hazard ratio 2.41, 95% confidence interval 1.38 to 4.20; log-rank p < 0.001). Subtype analysis showed increased rates of supraventricular tachycardia (3.5% vs. 1.3%) and atrial fibrillation or flutter (1.5% vs. 0.4%) in the EOSPE group. Conclusions EOSPE is independently associated with a significantly increased risk of new-onset maternal arrhythmia during pregnancy and the postpartum period. These findings support closer cardiovascular monitoring in this high-risk population.

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