Routine first‐trimester pre‐eclampsia screening and maternal left ventricular geometry

Preeclampsia (PE) is a pregnancy complication associated with premature cardiovascular disease morbidity and mortality. PE is associated with adverse left ventricular (LV) remodeling in the peripartum and postpartum period - an independent risk factor for cardiovascular disease. However, it is unknown if adverse cardiac remodeling is evident in the first trimester in participants at high compared to low risk of PE.This was a prospective cohort study of singleton pregnancies that underwent screening for preterm PE as part of their routine first-trimester ultrasound assessment at a tertiary center in London, UK, between February 2019 and March 2020 at 11+0 weeks' gestation through 13+6 weeks' gestation. Screening for preterm PE was performed using the Fetal Medicine Foundation algorithm. Participants with a screening risk of ≥1 in 50 for preterm PE were classified as high-risk and those with a screening risk of ≤1 in 500 were classified as low-risk. All participants underwent two-dimensional and M-mode transthoracic echocardiography.A total of 128 participants in the first trimester of pregnancy were included in the analysis, with 57 (44.5%) participants screened as low-risk and 71 (55.5%) participants high-risk for PE. The risk groups did not vary in maternal age and gestational age at assessment. Maternal body surface area (BSA) and body mass index (BMI) were significantly higher in the high-risk group (all p<0.05). The high-risk participants were significantly more likely to be Afro-Caribbean, nulliparous, have a history of hypertensive disease in pregnancy and a family history of cardiovascular disease (all p<0.05). In addition, mean arterial blood pressure (p<0.001), heart rate (p<0.05), left ventricular mass (130.06 g, 113.62-150.5 vs. 97.44 g, 81.68-114.16, p<0.001) and left ventricular mass index (72.87 ± 12.2 g/m2 vs. 57.54 ± 12.72 g/m2 , p<0.001) were significantly higher in the high-risk group. Consequently, the high-risk group were more likely to have abnormal left ventricular geometry (37.1% vs. 7.1%, p<0.001).Early echocardiographic assessment in participants at high-risk of preterm PE may unmask clinically healthy individuals who are at increased risk for future cardiovascular disease. Adverse cardiac remodeling in the first trimester of pregnancy may be an indicator of decreased cardiovascular reserve and subsequent dysfunctional cardiovascular adaptation in pregnancy. This article is protected by copyright. All rights reserved.