Clinical Outcomes of the Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women

BACKGROUND: Cardiovascular disease is increasingly recognized as a leading nonobstetric cause of maternal morbidity and mortality worldwide, including low- and middle-income countries. OBJECTIVES: This study evaluated fetomaternal outcomes in women with and without structural heart disease (SHD). METHODS: From a total of 25,000 patients enrolled in the Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women registry between February 2023 and April 2025, 489 pregnancies with SHD were identified and compared with 510 pregnancies without SHD. Adverse fetomaternal outcomes were evaluated in both groups as a composite endpoint, comprising fetal outcomes (preterm delivery, fetal death, or low birth weight) and maternal outcomes (maternal death and pulmonary edema). RESULTS: The SHD cohort had a higher mean maternal age (27.3 ± 5.7 vs 26.1 ± 5.2 years; P = 0.011) compared to the non-SHD cohort. Composite adverse maternal outcomes (3.7% vs 0.4%; P < 0.001), fetal outcomes (29.9% vs 13.3%; P < 0.001), and overall fetomaternal outcomes (30.7% vs 13.3%; P < 0.001) were significantly higher in the SHD compared to the non-SHD cohort. SHD was independently associated with adverse fetomaternal outcomes (adjusted OR: 2.67; 95% CI: 1.93-3.70; P < 0.001). CONCLUSIONS: Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women is the first global study linking subclinical echocardiographic abnormalities in asymptomatic pregnant women to adverse fetomaternal outcomes. In a large cohort of asymptomatic pregnant women, an abnormal echocardiogram was found to be associated with 2- to 4 time as many adverse fetomaternal outcomes compared to a normal echocardiogram. Future studies are needed to evaluate optimal timing of screening, cost-effectiveness, and applicability of broad antenatal screening in higher-income countries.