Relationship between hypertensive disorders of pregnancy (HDP) and cardiac remodeling during pregnancy: Systematic review and meta-analysis

Philip Eghan; Aba A Folson; Andrew Donkor; Collins Kokuro; Yaw Amo Wiafe

doi:10.1016/j.ejogrb.2024.05.003

Relationship between hypertensive disorders of pregnancy (HDP) and cardiac remodeling during pregnancy: Systematic review and meta-analysis

Eur J Obstet Gynecol Reprod Biol. 2024 May 9:298:108-115. doi: 10.1016/j.ejogrb.2024.05.003. Online ahead of print.

Authors

Philip Eghan¹, Aba A Folson², Andrew Donkor³, Collins Kokuro⁴, Yaw Amo Wiafe⁵

Affiliations

¹ Department of Radiology, University of Ghana Medical Centre, Accra, Ghana; Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
² Department of Internal Medicine and Therapeutics, School of Medicine, University of Health and Allied Sciences, Ho, Ghana.
³ Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁴ Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi Ghana.
⁵ Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Electronic address: ywiafe.chs@knust.edu.gh.

PMID: 38749071
DOI: 10.1016/j.ejogrb.2024.05.003

Abstract

Objectives: Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal morbidity and mortality. The primary objective of this study was to ascertain whether maternal cardiac remodeling is more prevalent in HDP than normotensive pregnancy and if significant change in aortic root size is involved. The secondary objective was to determine the types of cardiac remodeling often associated with HDP.

Methods: A systematic search was conducted across four electronic databases, including Medline, PubMed, Cochrane and EMBASE. The reference lists of selected articles were also searched to ensure no relevant studies were missed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed in this systematic review.

Results: Out of 5,278 articles identified by the search terms, 9 were eligible for inclusion in the meta-analysis. The investigation unveiled a greater prevalence of maternal cardiac remodeling in HDP than normotensive pregnancies. The commonest type of maternal cardiac remodeling in both HDP and normotensive pregnancies was eccentric left ventricular hypertrophy, followed by concentric left ventricular remodeling which was more specific to HDP. Notably, left atrial diameter was significantly increased in HDP than normotensive pregnancies, suggesting higher prevalence of diastolic dysfunction. Additionally, the aortic root dimension was significantly increased in HDP than normotensive pregnancies.

Conclusion: This study underscores the importance of monitoring cardiac health in pregnancy, particularly in those with hypertensive disorders, in order to mitigate potential complications and improve maternal outcomes. Finally, the risk of aortic dissection that may occur as a long-term effect of aortic root enlargement in women with history of HDP ought to be investigated in future studies.

Keywords: And aortic root; Cardiac remodeling; Echocardiography; Hypertensive disorders of pregnancy.

Publication types

Review