LAUSR

OBJECTIVE To evaluate rates of superimposed preeclampsia in pregnant individuals with echocardiography-diagnosed cardiac geometric changes in the setting of chronic hypertension. STUDY DESIGN This was a retrospective study of pregnant individuals with chronic hypertension who delivered singleton pregnancies at 20 weeks' gestation or greater at a tertiary care center. Analyses were limited to individuals who had an echocardiogram during any trimester. Cardiac changes were categorized as normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy according to the American Society of Echocardiography guidelines. Our primary outcome was early-onset superimposed preeclampsia defined as delivery at less than 34 weeks' gestation. Other secondary outcomes were also examined. Adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) were calculated, controlling for pre-specified covariates. RESULTS Of the 168 individuals who delivered from 2010 to 2020, 57 (33.9%) had normal morphology, 54 (32.1%) had concentric remodeling, 9 (5.4%) had eccentric hypertrophy, and 48 (28.6%) had concentric hypertrophy. Non-Hispanic black individuals presented over 76% of the cohort. Rates of the primary outcome in individuals with normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were 15.8%, 37.0%, 22.2%, and 41.7%, respectively (P =0.01). Compared to individuals with normal morphology, individuals with concentric remodeling were more likely to have the primary outcome (aOR 3.28; 95%CI 1.28-8.39), fetal growth restriction (crude OR 2.98; 95%CI 1.05-8.43), and iatrogenic preterm delivery <34 weeks' gestation (aOR 2.72; 95%CI 1.15-6.40). Compared to individuals with normal morphology, individuals with concentric hypertrophy were more likely to have the primary outcome (aOR 4.16; 95%CI 1.57-10.97), superimposed preeclampsia with severe features at any gestational age (aOR 4.75; 95%CI 1.94-11.62), iatrogenic preterm delivery < 34 weeks' gestation (aOR 3.60; 95%CI 1.47-8.81), and neonatal intensive care unit admission (aOR 4.82; 95%CI 1.90-12.21). CONCLUSION Concentric remodeling and concentric hypertrophy were associated with increased odds of early-onset superimposed preeclampsia.