First-trimester screening identifies maternal cardiac maladaptation in midgestation.

OBJECTIVE: We have previously established that a logistic regression model, based on maternal demographic characteristics and blood pressure measured at 11-13 weeks' gestation, can identify about 70% of women who develop future chronic hypertension (CH) in the 3 years following pregnancy, at a screen-positive rate of 10%. Furthermore, in midgestation, women who subsequently develop hypertensive disorders of pregnancy (HDP) have increased peripheral vascular resistance and mild cardiac functional and morphological alterations and these cardiovascular abnormalities persist for at least 2 years after delivery. In this study, we set out to examine whether use of the first-trimester risk model for subsequent development of CH can help to identify women at high risk for cardiovascular maladaptation in midgestation. METHODS: This was a prospective observational study of 3812 women with singleton pregnancy attending for a routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation and again at 19 + 1 to 23 + 3 weeks at King's College Hospital, London, UK, between December 2019 and August 2020. The first-trimester visit included recording of maternal demographic characteristics and medical history and measurement of systolic and diastolic blood pressure. In midgestation, detailed maternal cardiovascular assessment was carried out. The association between risk for development of CH, determined from first-trimester assessment, and cardiovascular indices in midgestation was examined. RESULTS: Women who were at high risk for development of future CH, compared to those at low risk, had a higher incidence of HDP. In addition, high-risk women had reduced systolic and diastolic function in midgestation. Among women with HDP, those who were at high risk for future CH, compared to those at low risk, had worse cardiac function in midgestation. CONCLUSIONS: Use of a model for first-trimester prediction of subsequent development of CH can identify women who show evidence of cardiac maladaptation in midgestation. Further studies are needed to clarify whether women who screen as high risk for future CH, compared to those at low risk, have reduced cardiac function beyond pregnancy. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Fetal cardiac function at midgestation and conception by in-vitro fertilization.

OBJECTIVE: To assess differences in cardiac morphology and function at midgestation in fetuses conceived by in-vitro fertilization (IVF), using fresh or frozen embryo transfer, compared with those conceived naturally. METHODS: This was a prospective study of 5801 women with a singleton pregnancy attending for a routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation, including 343 that conceived by IVF. Conventional and more advanced echocardiographic modalities, including speckle-tracking analysis, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity index. Placental perfusion and function were assessed by measurement of uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF), respectively. RESULTS: Fetuses that were conceived by IVF, compared with those conceived spontaneously, had significantly lower right and left ventricular sphericity index, higher left ventricular global longitudinal strain and lower left ventricular ejection fraction. There were no significant differences in any of the cardiac indices within the IVF group between the fresh and frozen embryo transfers. In the IVF group, compared with spontaneously conceived pregnancies, UtA-PI was lower and PlGF was higher, suggesting better placental perfusion and function. CONCLUSIONS: Our study demonstrates that, in IVF pregnancies, compared with those conceived spontaneously, there is evidence of fetal cardiac remodeling at midgestation, which is not related to the use of fresh or frozen embryo transfer. In the IVF group, compared with naturally conceived pregnancies, fetal heart was globular and left ventricular systolic function was mildly reduced. Whether these cardiac changes are accentuated later in pregnancy and remain in the postnatal period remains to be established. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Maternal cardiac function in twin pregnancy at 19-23 weeks' gestation.

OBJECTIVES: To compare maternal cardiovascular indices at 19-23 weeks' gestation between twin and singleton pregnancies and assess the impact of chorionicity on these parameters. METHODS: This was a prospective observational study in women with twin pregnancy attending for a hospital visit at 19 + 1 to 24 + 3 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history and maternal cardiovascular assessment. In a previous study of 4795 women with singleton pregnancies at 19-23 weeks' gestation, multivariable linear regression models were fitted between the various cardiovascular indices and elements of maternal characteristics and medical history. In this study, we calculated multiples of the median (MoM) and delta values according to the singleton models and assessed the distributional properties of these MoM and delta values in twin as compared with singleton pregnancies. RESULTS: The study population of 155 women with twin pregnancy included 86 dichorionic and 69 monochorionic cases. In general, there was a similar distribution of maternal cardiovascular indices in monochorionic and dichorionic twin pregnancies. In both types of twin pregnancy, compared with singleton pregnancy, there was an increase in isovolumetric relaxation time, left atrial area and myocardial performance index, and a decrease in mitral valve E/A. Left ventricular mass indexed for body surface area and relative wall thickness were also increased in twin compared with singleton pregnancy. The magnitude of the increase in left atrial area was greater in dichorionic compared with monochorionic pregnancies. Additionally, mitral valve E was decreased and left atrial volume was increased in dichorionic but not in monochorionic pregnancies, while isovolumetric contraction time was increased in monochorionic but not in dichorionic pregnancies. Left ventricular myocardial deformation was similar between twin and singleton pregnancies. CONCLUSIONS: In twin pregnancies at mid-gestation, maternal systolic and diastolic function is reduced when compared with singletons. The patterns of cardiovascular adaptation are similar between monochorionic and dichorionic pregnancies and resemble those reported in uncomplicated singleton pregnancy later in gestation. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.