Postpartum anthropometric and cardiovascular profile following hypertensive disorders of pregnancy: 12-month follow-up.

Abstract

Objectives: To compare anthropometric and cardiovascular parameters at 6-12 weeks postpartum among women classified at first-trimester screening as high risk for pre-eclampsia (PE) who subsequently developed hypertensive disorders of pregnancy (HDP), those classified as high risk who did not develop HDP and those classified as low risk for PE, and, among high-risk women, to evaluate the trajectory of these parameters from 6-12 weeks to 12 months postpartum according to the subsequent development of HDP.

Methods: This was a prospective postpartum longitudinal study conducted at the Prince of Wales Hospital, Hong Kong Special Administrative Region, in which women underwent postpartum assessment between October 2022 and January 2025. Eligible participants were Chinese women in the postpartum period following a singleton pregnancy who had undergone first-trimester PE screening at 11 + 0 to 13 + 6 weeks' gestation. Women were classified into three groups based on their first-trimester screening result and subsequent pregnancy outcome: (1) women at high risk (≥ 1:100) for PE who subsequently developed HDP; (2) women at high risk for PE who did not develop HDP; and (3) low-risk controls with a normotensive pregnancy. Participants were enrolled between 6 and 12 weeks postpartum for anthropometric and cardiovascular assessments, and these findings were compared among the groups. Subsequently, women at high risk for PE were examined longitudinally at 6 months and 12 months postpartum to assess changes in anthropometric and cardiovascular parameters. High-risk women received lifestyle counseling at each visit. Linear mixed-effects analysis was performed to compare the longitudinal changes in anthropometric and cardiovascular parameters over the postpartum period.

Results: Overall, 201 women were included in the study, of whom 130 were at high risk for PE and did not develop HDP, 41 were at high risk for PE and developed HDP and 30 were low-risk controls. At 6-12 weeks postpartum, high-risk women with HDP exhibited a significantly higher mean arterial pressure, left ventricular (LV) mass index (MI), systemic vascular resistance, myocardial performance index and more impaired global longitudinal strain (GLS), along with lower mitral annular plane systolic excursion, compared with the low-risk and high-risk-without-HDP groups. Similar findings mostly persisted over the 12-month postpartum period, even after adjusting for risk factors (all P < 0.05). From 6 to 12 weeks to 12 months postpartum, the high-risk-without-HDP group showed a statistically significant declining trend in weight, waist circumference and waist-to-hip ratio, along with reduced weight gain from the first trimester to 12 months postpartum, whereas the high-risk-with-HDP group showed no significant change during the same period. The high-risk-without-HDP group exhibited a decreasing trend in LV-MI and increasing trends in LV ejection fraction, GLS, left atrial emptying fraction and left atrial expansion index from 6-12 weeks to 6 months postpartum. Conversely, in the high-risk-with-HDP group, these improvements only became apparent at 12 months postpartum (all P < 0.05).

Conclusions: Women identified as being at high risk for PE at first-trimester screening, particularly those who develop HDP, exhibit consistently suboptimal anthropometric and cardiovascular trajectories during the first year postpartum. The observed association between maternal risk factors and an unfavorable cardiovascular profile underscores the need to extend anthropometric and cardiovascular screening and implement personalized interventions beyond the standard 6-12-week postpartum visit in women with HDP. However, the feasibility and practicality of postpartum cardiovascular surveillance are limited by disparities in access to echocardiography, resource allocation for prolonged follow-up and challenges in improving patient engagement in postpartum care. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.