Structural and functional echocardiographic characteristics in women with preeclampsia–eclampsia: a comparative study in northwestern Tanzania

Background Preeclampsia–eclampsia is a multisystem hypertensive disorder associated with structural and functional cardiac alterations. However, echocardiographic data from low-resource settings remain limited. This study compared structural and functional echocardiographic characteristics between women with preeclampsia–eclampsia and normotensive pregnant women attending Bugando Medical Centre in northwestern Tanzania. Methods A comparative cross-sectional study was conducted among 273 women who were at least 28 weeks pregnant or within 10 days postpartum between January 2022 and January 2023. Participants comprised 135 women with preeclampsia–eclampsia and 138 normotensive controls. Transthoracic echocardiography was performed to assess cardiac structure and function. The primary outcomes were composite structural and functional echocardiographic abnormalities. Multivariable logistic regression was used to evaluate the association between blood pressure severity and echocardiographic abnormalities after adjustment for age, body mass index, parity, referral status, and timing of echocardiographic assessment. Results Composite structural echocardiographic abnormalities were significantly more common among women with preeclampsia–eclampsia than among normotensive women (55.6% vs. 26.8%, p < 0.001), as were composite functional abnormalities (40.0% vs. 23.9%, p = 0.004). Women with preeclampsia–eclampsia had significantly greater interventricular septal thickness, left ventricular posterior wall thickness, and relative wall thickness, while left ventricular internal dimensions did not differ significantly between groups. Reduced left ventricular ejection fraction (11.9% vs. 5.1%, p = 0.044) and diastolic dysfunction (31.1% vs. 20.3%, p = 0.041) were more prevalent in the preeclampsia–eclampsia group. Increasing systolic and diastolic blood pressure severity remained independently associated with composite structural abnormalities after multivariable adjustment, whereas no independent association was observed with the composite functional outcome. Conclusion Women with preeclampsia–eclampsia had a significantly higher prevalence of structural and functional echocardiographic abnormalities than normotensive women. Structural abnormalities were more strongly related to increasing blood pressure severity than functional abnormalities, suggesting that hypertensive load is an important determinant of maternal cardiac structural adaptation. Prospective longitudinal studies are needed to determine the persistence and prognostic significance of these abnormalities after pregnancy.