Preeclampsia, eclampsia, and gestational hypertension are known “hypertensive disorders of pregnancy” that affect mothers and babies. HDP's bodily effects are well known, but not its cardiac effects. To better understand HDP's cardiac features and their predictive relevance for maternal outcomes, this study analyses echocardiography abnormalities in pregnant women with HDP with normotensive women. One prospective cohort research comprised 18–45-year-old pregnant women. The pregnant women were divided into HDP and control groups. Both baseline and pregnancy echocardiograms were done on HDP patients. Statistical studies of demographic and clinical data were used to predict and compare echocardiographic characteristics between groups. Echocardiographic abnormalities in HDP women included enlarged “left atrial volume index (LAVI),” decreased LVEF, increased LVMI, and changed diastolic function parameters. Dynamic cardiac parameter alterations were seen in longitudinal pregnancy investigations. Logistic regression demonstrated these cardiac characteristics predict poor maternal outcomes. Subgroup investigations found more cardiac abnormalities in severe preeclampsia. HDP is linked to left ventricular hypertrophy, enlarged left atrium, and impaired diastolic and systolic function. Changes in the heart affect the mother, foetus, and future generations instantaneously and over time. Echocardiographic values may predict poor maternal outcomes in HDP women, emphasising cardiac surveillance. HDP's bigger cardiovascular consequences require further study and interdisciplinary care to enhance outcomes.
TopIntroduction
Preeclampsia, eclampsia, and gestational hypertension collectively refer to HDP, which poses a serious and complex public health risk that cuts across regional and demographic divides (American College of Obstetricians and Gynecologists, 2019). These illnesses, which are defined by high blood pressure during pregnancy, can present as a range of disorders of different degrees of severity that affect the health of both the mother and the foetus (Sibai, 2012). Because HDP contributes significantly to maternal morbidity and death, it is still a serious concern in the field of obstetrics, necessitating ongoing research and understanding of the complex aspects of this disease by policymakers, researchers, and healthcare professionals (Pandit, 2023). This introduction explores HDP's prevalence, pathogenesis, clinical presentations, and outcomes, highlighting the importance of using echocardiography to examine the condition's cardiac components specifically (Tak & Sundararajan, 2023).
Prevalence and Global Impact: The frequency of hypertensive disorders during pregnancy varies by geography and population, affecting a significant percentage of pregnant women worldwide (Messerli et al., 2007). Although the exact prevalence numbers may vary, it is impossible to overlook the overall impact of HDP. According to the “World Health Organisation (WHO)”, hypertensive disorders are a major cause of maternal mortality, accounting for 10% of maternal fatalities globally (Nagueh et al., 2016). The incidence of pregnancies is thought to be between 5 and 10% in high-income nations and up to 25% or more in low-income ones (Ponikowski et al., 2016). It is also critical to acknowledge that the prevalence of HDP is rising, which can be linked to a number of variables, such as alterations in lifestyle, advancing maternal age and enhanced diagnostic standards (Mabie et al., 1992). These worldwide data highlight the necessity for a thorough investigation to fully grasp the range of effects of HDP on maternal health, especially with regard to its consequences for the heart.
Pathophysiology of HDP: Placental, vascular, and immune system changes are all part of the complicated and multifaceted pathophysiology of HDP (Bellamy et al., 2007). Endothelial dysfunction is a crucial and unifying element in the development of HDP, despite the fact that much research has been done to clarify complex aetiology. In early pregnancy, poor trophoblast invasion and spiral artery remodelling set off a series of events (Tak et al., 2023). This causes placental ischemia, which sets off the production of molecules such as “soluble endoglin (sEng)” and soluble fms-like tyrosine kinase-1 (sFlt-1), which cause the systemic endothelial dysfunction linked to HDP (Garcia-Gonzalez et al., 2020). As a result, the syndrome's extensive symptoms, such as organ involvement, proteinuria, and hypertension, are influenced by this endothelial dysfunction (Modin et al., 2018).
Because of the systemic endothelial dysfunction caused by HDP, the heart system is especially susceptible to its effects. The cardiac strain is further aggravated by increased blood pressure and the release of vasoactive chemicals, such as angiotensin II (Halley et al., 2011). Given that HDP's cardiac pathophysiology may have a major impact on a mother's health, understanding it is essential. Subclinical alterations to serious difficulties can result from cardiac involvement in HDP, which could have catastrophic effects on the mother and the foetus (Ghossein-Doha et al., 2013). Due to its complexity, a more thorough investigation of the cardiac components of HDP is required, with an emphasis on echocardiographic assessments to determine the health and functioning of the heart.