Cardiac remodeling in morbidly obese women and its association with adverse perinatal outcomes

Objectives: To determine the association of cardiac remodeling in early pregnancy and adverse perinatal outcomes among women with BMI >= 40 kg/m(2). Study design: We performed a retrospective cohort study including women with BMI >= 40 kg/m(2) without known cardiac disease. Women who underwent screening transthoracic echocardiography prior to gestational age 24 weeks were included. Women were analyzed by group with normal or abnormal geometry, including concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Multivariable logistic regression was used to assess the association of abnormal geometry with perinatal outcomes. We had 80% power with alpha 0.05 to detect a 3.0-fold increase in the primary outcome among women with abnormal geometry. Main outcome measures: Our primary outcome was a composite of adverse perinatal outcomes including any 1 of the following: preterm birth ( < 37 weeks), low birth weight ( < 2500 g), or hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. Results: Of 140 women, 53 (37.9%) had abnormal geometry. The average BMI was similar between those with normal and abnormal geometry (44.7 vs. 44.2 kg/m(2), p = 0.53). The primary outcome occurred in 20.7% with normal geometry and 30.2% with abnormal geometry (p = 0.20). After adjustment for parity, chronic hypertension, and tobacco use, abnormal cardiac geometry was not associated with the composite primary outcome (adjusted OR 2.01 [95% CI 0.84-4.78]) but was associated with hypertensive disorders of pregnancy (adjusted OR 2.82 [95% CI 1.03-7.78]). Conclusions: Cardiac remodeling early in pregnancy is associated with hypertensive disorders of pregnancy.