Cardiac remodelling and diastolic function in pregnancies complicated by cardiometabolic disorders

Abstract Background During pregnancy, significant maternal cardiovascular adaptations are required to support placentation and foetal growth. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) alter cardiac function, yet the temporal dynamics of these changes in early pregnancy are inadequately studied. Purpose The study aimed to evaluate early pregnancy diastolic function, cardiac remodelling, and their temporal progression in women who developed cardiometabolic (CM) complications during pregnancy compared to those with uncomplicated pregnancies. Methods 43 nulliparous women with singleton pregnancies, without chronic hypertension or diabetes mellitus, were prospectively followed throughout pregnancy in a university medical centre. Maternal echocardiography and blood pressure (BP) measurements were performed at two timepoints: at 11+0 – 15+6 and at 24+0 – 28+6 weeks of gestation. Echocardiographic assessments were performed in accordance with the European Association of Cardiovascular Imaging guidelines. Office BP was measured in a seated position, three times on each arm. Pregnancy outcomes were collected, and participants were categorized into three groups: HDP, GDM, and no CM complications. Linear mixed-effects models were used to analyse the parameters, adjusting for time, group, and their interaction. Results Between the groups with no CM complications, GDM and HDP, there were significant differences in mean body mass index (22.5±3.0, 26.8±6.1 and 24.2±3.7 kg/m2, respectively; p=0.047), systolic BP (107.8±7.3, 112.9±16.0 and 118.8±14.1 mmHg, respectively; p=0,013) and diastolic BP (72.3±6.5, 73.2±10.4, 77.2±9.2 mmHg, p=0,020). Mean ages at enrolment were 32.6±4.9, 32.6±5.8 and 33.4±5.8 years, respectively (p=n.s.). The GDM and HDP groups showed distinct and progressive alterations in diastolic function and cardiac remodelling over time (Table 1). Compared to the no CM complications group, women who developed GDM during pregnancy had higher unindexed left ventricular mass (LVM) in early pregnancy. At the second timepoint, a progressive increase in unindexed left ventricular end diastolic volume (LVEDV) and unindexed left atrial volume (LAV) was evident. Women who subsequently developed HDP had greater wall thickness and LV mass at both timepoints compared to the no CM complications group, while differences in e’ septal, e’ lateral and E/e’ became significant only at the second timepoint, indicating progressive impairment over time. For unindexed LVEDV and unindexed LAV, the temporal changes significantly differed between groups (Figure 1). Conclusions HDP and GDM lead to distinct cardiac remodelling and diastolic function alterations during pregnancy. Temporal changes highlight the progressive nature of the impact of pregnancy-related CM complications and further emphasize the importance of risk stratification and individualized management of pregnant women at increased CM risk.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.