TEMPORAL DYNAMICS OF CARDIOVASCULAR REMODELING DURING PREGNANCY IN WOMEN WITH HYPERTENSIVE DISORDERS AND GESTATIONAL DIABETES

Objective: During pregnancy, significant maternal cardiovascular adaptations are required for appropriate placentation and fetal growth. This study aimed to assess the temporal progression of hemodynamic profiles and cardiac remodeling during pregnancy in women with hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and those without cardiometabolic complications.Design and method: We enrolled 170 nulliparous women with singleton pregnancies between 11+0 and 15+6 weeks of gestation. Echocardiographic assessments, performed by experienced clinicians according to the European Association of Cardiovascular Imaging guidelines, were conducted at baseline and repeated at 24+0 – 28+6 weeks. Participants were classified into three groups: HDP, GDM, and no cardiometabolic complications. Pregnancy outcomes were recorded, and statistical analysis was performed to evaluate the effects of time and group on cardiac parameters. Results: Linear mixed-effects models were used to analyze the effects of Timepoint and Group on several echocardiographic parameters: RWT, GLS, septal s, and E/e. For RWT, a significant time effect was found (p < 0.0001), with hypertension showing a positive effect (p = 0.045), while diabetes and interactions had no significant impact. GLS demonstrated a significant time effect (p = 0.0001), but no group differences or interactions were observed. Septal s showed a significant time effect (p < 0.0001), with no group differences. E/e exhibited a significant time effect (p = 0.0051), with hypertension showing a near-significant increase (p = 0.0868). These results highlight that the cardiovascular changes observed were not confined to single timepoints but reflect a dynamic evolution of parameters throughout pregnancy, with distinct trends depending on the type of complication. Conclusions: Our study demonstrates that there are specific temporal trends in cardiac parameters associated with each type of pregnancy complication. Hypertensive disorders of pregnancy and GDM both lead to distinct changes in cardiac remodeling and hemodynamics during pregnancy, highlighting the progressive nature of these alterations. In particular, even in GDM, we observed significant modifications in cardiac function over time, further emphasizing the importance of early monitoring and individualized management for pregnant women at cardiometabolic risk.