Longitudinal Assessment of Fetal Ventricular Geometry and Function in Hypertensive Pregnancies

BACKGROUND: Maternal hypertension has a complex and not fully understood impact on the fetal heart. OBJECTIVE: The study investigated the impact of various forms of maternal hypertension on fetal heart function and ventricular remodeling and follows up postnatal outcomes. METHODS: The research involved 45 pregnant women with hypertension and 15 with normal pregnancies. Fetal echocardiograms were conducted between 24 and 34 weeks of pregnancy using various methods to evaluate cardiac function. The study measured ventricular transverse and longitudinal diameters, along with the sphericity index. Follow-up postnatal echocardiograms were also conducted. RESULTS: The study included 15 cases each of gestational hypertension, chronic hypertension, and preeclampsia, with 15 control subjects. The E/A ratio of the tricuspid valve was significantly lower in fetuses in all groups compared to the control group. The E wave was significantly reduced in the chronic hypertension and preeclampsia groups (p < 0.001) compared to the control group. The Tei Doppler index for the left and right ventricles was significantly higher in both chronic hypertension and preeclampsia groups, affecting both fetuses and neonates. However, there was no statistically significant difference in gestational hypertension for either fetuses or neonates. In fetuses, the left ventricle had a decreased transverse dimension in both the chronic hypertension and preeclampsia groups (p < 0.001 and 0.002). In neonates, the transverse diameter decreased significantly in all groups (p < 0.037, 0.005, and 0.012 respectively). The right ventricle showed a significant increase in transverse diameter in the chronic hypertension and preeclampsia groups in fetuses and only in the chronic group in neonates. The E' wave was also significantly different in both the preeclampsia and chronic hypertension groups. The E/ E' of the left ventricle in preeclampsia was statistically significant in both fetuses and neonates. CONCLUSION: Hypertensive pregnancies can affect fetal cardiac function and structure, which may persist into the early days of life.