Adverse pregnancy outcomes are associated with cardiovascular and renal dysregulation in late pregnancy

Emerging evidence links adverse pregnancy outcomes (APOs), including gestational diabetes, pregnancy-induced hypertension (PIH), preterm birth, fetal growth restriction and placental abruption to heightened long-term cardiovascular and renal (CVR) disease risks. CVR dysregulation in late pregnancy may be associated with APOs, but the relationship remains understudied. This study investigated CVR biomarkers alterations in women with APOs, assessed cardiorenal interactions, explored dose-response relationships with APO number, and evaluated independent risk factors. A case-control study was conducted on 340 singleton pregnancies (170 uncomplicated controls, 170 APO cases) at a tertiary maternity hospital in Shanghai. Cardiac hemodynamic markers, including cardiac index (CI) and systemic vascular resistance index (SVRI), were assessed with the USCOM-1 A monitor. Serum levels of cardiac biomarkers (B-type natriuretic peptide [BNP], myoglobin [MYO], creatine kinase isoenzymes [CKMB]) and renal biomarkers (uric acid [UA], blood urea nitrogen [BUN], creatinine [Cr]) were measured, with estimated glomerular filtration rate (eGFR) calculated using the CKD-EPI equation. Correlation analysis and logistic regression were used; sensitivity analyses excluded PIH and placental abruption. Compared to controls, APO cases had significantly lower CI, higher SVRI, and elevated BNP, MYO, UA, and BUN (all p < 0.05). Positive linear trends were observed for SVRI, MYO, UA, BUN, and Cr, while negative trends occurred for CI and eGFR, demonstrating a dose-response relationship with increasing APO number. Significant correlations existed between renal (eGFR, Cr) and cardiovascular markers (CI, SVRI), with stronger associations in multiple-APO cases. A positive correlation between eGFR and BNP was observed only in women with two or more APOs (r = 0.283, p = 0.016). Independent risk factors included UA (aOR 4.46, 95%CI 1.39–14.35, p = 0.012), SVRI (aOR 3.58, 95%CI 1.13–11.36, p = 0.03), MYO (aOR 2.50, 95%CI 1.01–6.18, p = 0.046), and pre-pregnancy BMI (aOR 1.08, 95%CI 1.02–1.15, p = 0.007). Sensitivity analysis excluding PIH attenuated most CVR associations, indicating PIH primarily drove the findings. Our findings support the value of monitoring CVR biomarkers in late pregnancy to identify women with established or evolving for APOs and suggest potential targets for intervention to mitigate long-term CVR risks. Future longitudinal studies are required to evaluate early-pregnancy predictive potential across APO subtypes.