Key result
Hypertensive disorders of pregnancy linked to worse fetal LV global longitudinal strain.
Why the study?
Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia (PE) and gestational hypertension (GH), create an adverse intrauterine environment, but their impact on fetal cardiac function is not well understood.
Does exposure to hypertensive disorders of pregnancy impair fetal myocardial function (LVEF, LVGLS, RVGLS) compared to healthy pregnancies?
Meta-Analysis (n=7,999)
Does exposure to hypertensive disorders of pregnancy impair fetal myocardial function (LVEF, LVGLS, RVGLS) compared to healthy pregnancies?
Fetuses of pregnant women with hypertensive disorders of pregnancy, particularly pre-eclampsia, exhibit significant subclinical left ventricular myocardial dysfunction characterized by impaired global longitudinal strain.
Hypothesis-generating for subclinical fetal cardiac effects in HDP; prospective studies needed before any clinical adoption.
Introduction Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia (PE) and gestational hypertension (GH), create an adverse intrauterine environment that can affect fetal growth and cardiac fetal dysfunction. However, the impact of HDF in cardiac fetal function is not well understood. Purpose We aimed to conduct a systematic review and meta-analysis evaluating cardiac fetal dysfunction in pregnant women with HDP. Methods A systematic search was conducted in PubMed, Embase, and Cochrane database for studies evaluating cardiac fetal function in patients with HDP. Echocardiography parameters were collected, and the outcomes were: 1) Left ventricular (LV) function: LV ejection fraction (LVEF) and LV global longitudinal strain (LVGLS); and 2) Right ventricular (RV) function: RV global longitudinal strain (RVGLS). Statistical analysis was performed using RStudio. Pooled mean differences (MD) were estimated using a random-effects model, with a significance level of 0.05. Confidence interval (CI) of 95% was adopted and heterogeneity was accessed using I². Results Six observational studies were included, with 7.999 patients. LV function was significantly reduced in fetuses of pregnant women with HDP. LVGLS in fetuses of pregnant women with HDP were reduced (MD 1.17 [CI 95%: 0.23 to 2.11]; p=0.015; I² 0% - Figure 1A) and also even more impaired in pregnant women with PE (MD 1.31 [CI 95%: 0.56 to 2.06]; p<0.001; I² 16.3%- Figure 2A), when compared with healthy pregnant women. Compared with the control group, fetal LVEF was discreetly reduced in HDP (MD -0.02 [CI 95%: -0.04 to 0.00]; p=0.015; I² 32.8% - Figure 1C), but not in PE (MD -0.02 [CI 95%: -0.05 to 0.01]; p=0.20; I² 40.4% - Figure 2C). RV function did not show a significant reduction in pregnant women with HDP (MD -2.02 [CI 95%: -0.10 to 4.13]; p=0.06; I² 89.3% - Figure 1B) nor in PE (MD 0.61 [CI 95%: -1.42 to 2.63]; p=0.55; I² 95.5% - Figure 2B). Conclusion Fetuses of pregnant women with HDP, and specially PE, have reduction in LV myocardial function, with a decline in LVGLS.Figure 1Figure 2
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Carvalho et al. (2026) conducted a meta-analysis in Hypertensive disorders of pregnancy (pre-eclampsia and gestational hypertension) (n=7,999). Hypertensive disorders of pregnancy (HDP) vs. Healthy pregnant women was evaluated on Fetal left ventricular global longitudinal strain (LVGLS) (MD 1.17, 95% CI 0.23 to 2.11, p=0.015). Hypertensive disorders of pregnancy were associated with reduced fetal LV global longitudinal strain vs healthy pregnancies (MD 1.17; 95% CI 0.23-2.11; p=0.015).
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