Risk Stratification Models to Predict Hypertensive Disorders of Pregnancy: Additive Value of Standard Electrocardiography

Hypertension disorders complicate up to 10%-11% of all pregnancies and remain leading causes of poor outcome, including placental abruption, organ failure, cerebrovascular accident and disseminated intravascular coagulation. These disorders are also associated with increased risk of perinatal death, fetal intrauterine growth restriction, and prematurity/preterm delivery. Epidemiological evidences supporting the worse prognosis associated with hypertension in pregnancy provide a strong basis for developing perinatal morbidity and mortality risk prediction models. Of the many risk markers for hypertensive disorders, some are known at booking and increase the risk of hypertensive disorders twoto four-fold. They include pre-existing hypertension, diabetes mellitus and renal disease, previous preeclampsia, antiphospholipid antibody syndrome, overweight/obesity, inter-pregnancy interval ≥ 10 years, and multiple pregnancies. Recently, the additive value of some instrumental techniques (including uterine artery Doppler velocimetry, electrocardiography and ambulatory blood pressure monitoring) and their combinations with maternal factors and biochemical markers to refine risk stratification for hypertensive disorders in pregnancy has also been evaluated. The main aim of our systematic review was to summarize the present state of knowledge in this active area of broad interest. Specifically, we aimed to provide an overview of recent contributions on the role of electrocardiography for the identification of women at increased risk of hypertensive complications during pregnancy. Briefly, current Guidelines recommend performing a 12lead electrocardiogram in order to evaluate the presence of left ventricular hypertrophy in pregnant women. Nevertheless, some abnormal electrocardiographic patterns, particularly in the first trimester of pregnancy, may increase the risk of maternal and neonatal complications. In this context, left atrial abnormalities in lead V1 have been suggested as independent predictors of hypertensive disorders and other pregnancy complications including fetal growth restriction, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, placental abruption, stillbirth, premature delivery and neonatal death. Available data support the notion that risk stratification for hypertensive disorders might be improved in the first-trimester of pregnancy using standard electrocardiography in combination with maternal characteristics and history. An effective screening for hypertensive disorders is useful to identify women that would potentially benefit from a closer surveillance and from prophylactic pharmacological interventions.