Screening Echocardiogram in High-Risk Women with Class III Obesity to Predict the Risk of Preeclampsia

Objective Women with obesity and other comorbidities such as hypertension and diabetes are at an increased risk of preeclampsia and perinatal morbidity. This study evaluates whether screening echocardiogram can identify women with obesity at a higher risk of preeclampsia. Methods We conducted a retrospective cohort study of women with class III obesity (body mass index [BMI] ≥40 kg/m (2) ) and one or more medical comorbidities associated with an increased risk of preeclampsia (such as diabetes, hypertension, and rheumatologic disease) undergoing screening echocardiogram. Abnormal findings were defined as the presence of one or more of the following: diastolic dysfunction, ejection fraction of ≤45%, or cardiac chamber enlargement or hypertrophy. Multivariable logistic regression was used to estimate the odds ratio (OR) of gestational hypertension/mild preeclampsia, severe preeclampsia, and any preterm delivery <37 weeks associated with abnormal echocardiographic findings when controlling for potential confounders. Results Of 267 eligible women, 174 (64%) underwent screening echocardiograms. Sixty-nine women (40%) had abnormal echocardiograms. Maternal clinical characteristics were similar between women with normal echocardiographic findings and women with abnormal findings. Women with abnormal echocardiograms were more likely to have chronic hypertension (78 vs. 62%, p = 0.04) and a history of preeclampsia (27 vs. 10%, p = 0.02). After controlling for confounders, women with abnormal echocardiogram were at an increased risk of hypertensive disorders of pregnancy, OR 6.80 (95% confidence interval [CI] 3.32–13.93, p = 0.01), and in particular severe preeclampsia, OR 8.77 (95% CI 3.90–19.74, p = 0.01). Conclusion Among pregnant women with class III obesity and medical comorbidities, screening echocardiogram may help identify a subset of women at the highest risk of developing preeclampsia. Key Points: Women with obesity and comorbid conditions are at a high risk of abnormal echocardiogram. Women with obesity, medical comorbid conditions, and abnormal echo are at a high risk of preeclampsia. Screening echocardiogram can help identify obese women at the highest risk of severe preeclampsia.