Echocardiographic Assessment of the Maternal Heart: A Review of the Structural and Functional Changes During Pregnancy

To accommodate the growing needs of the developing fetus during pregnancy, the female cardiovascular system undergoes substantial changes, including increases in blood volume, heart rate (HR), and cardiac output (CO), as well as decreases in systemic vascular resistance (SVR). These alterations typically emerge early in pregnancy, last until the third trimester, and eventually return to baseline approximately 6 months after delivery. Accordingly, the maternal heart has undergone remodeling and postpartum-induced reverse remodeling. Most pregnant women possess a high cardiac reserve; however, if the cardiovascular changes exceed a mother's ability to adapt, it may lead to cardiovascular diseases (CVDs) during pregnancy. Echocardiography is widely employed to evaluate the maternal heart during pregnancy. Advances in speckle-tracking echocardiography (STE) and non-invasive myocardial work (myW) quantification technologies facilitate the early detection of cardiac remodeling and dysfunction. This review summarizes the physiological changes in the maternal cardiovascular system during pregnancy and discusses recent advancements in imaging techniques used for cardiac evaluation in healthy women, those with cardiovascular risk (CVR) factors such as simple obesity, gestational diabetes mellitus, and preeclampsia, and women with structural heart diseases.