Longitudinal maternal hemodynamics in high‐risk pregnancies with different subtypes of pre‐eclampsia

OBJECTIVE: To evaluate maternal cardiac adaptation during pregnancy by comparing longitudinal hemodynamic profiles between women identified as high risk for preterm pre-eclampsia (PE) who subsequently developed preterm PE, term PE or remained unaffected, as well as low-risk women. METHODS: -transformed values for hemodynamic variables were compared between the groups throughout pregnancy and at each clinical visit. RESULTS: Compared with Group 1, all high-risk groups exhibited lower SV and CO and higher SVR and MAP throughout pregnancy (all P < 0.05), while HR was significantly elevated in Group 2 (P < 0.001). Compared with Group 2, Group 4 had lower HR, SV and CO and higher SVR and MAP throughout pregnancy (all P < 0.01). In contrast, Group 3 showed no significant differences in HR, SV, CO and SVR compared with Group 2 (all P > 0.05), although there was an increase in MAP from midgestation onwards (P < 0.001). Compared with Group 3, Group 4 exhibited lower CO and higher SVR and MAP throughout pregnancy (all P < 0.05). CONCLUSIONS: Compared with low-risk women who do not develop PE, high-risk women with or without preterm or term PE exhibit distinct cardiac maladaptation profiles from early to late gestation. These findings offer insight into the different pathophysiological mechanisms underlying PE subtypes and should inform risk stratification. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.