Left ventricular hypertrophy as a predictor of adverse maternal and neonatal outcomes in chronic hypertension in pregnancy: a multicenter study

OBJECTIVE: The impact of chronic hypertension (CHTN) combined with left ventricular hypertrophy (LVH) on adverse maternal and fetal pregnancy outcomes remains unclear. METHODS: This multicenter retrospective cohort study included pregnant women with CHTN from four tertiary hospitals in China. Baseline characteristics were compared using the Kruskal-Wallis and Chi-squared tests with Bonferroni correction. Logistic regression (LR) identified risk factors for adverse outcomes. Four machine learning (ML) algorithms were validated, nomograms were developed for model visualization, and SHapley Additive exPlanations (SHAP) determined variable importance. RESULTS: Among 500 women, 117 (23.4%) had normal geometry, 118 (23.6%) concentric remodeling, 88 (17.6%) eccentric hypertrophy, and 177 (35.4%) concentric hypertrophy. Adverse maternal and fetal outcomes occurred in 126 (25.2%) and 359 (71.8%) women, respectively. LVH was independently associated with adverse maternal outcomes (OR 2.16, 95% CI 1.13-4.13) and fetal outcomes (OR 2.42, 95% CI 1.31-4.45). Additional maternal predictors included NYHA class III-IV, pre-eclampsia, oligohydramnios, elevated alanine aminotransferase and lactate dehydrogenase, hypoalbuminemia, greater bleeding loss, and blood transfusion. Fetal predictors included increased posterior wall thickness, oligohydramnios, abnormal umbilical artery flow, elevated alanine aminotransferase and blood urea nitrogen, low total protein, and proteinuria. ML models showed AUCs of 0.70-0.87 for maternal and 0.80-0.88 for fetal outcomes; SHAP identified LVH as an important contributor in both models. CONCLUSION: Early-pregnancy LVH was associated with higher risks of adverse maternal and fetal outcomes in women with CHTN. These models may support individualized risk stratification but require prospective external validation before clinical implementation.