Late-pregnancy metabolic dysregulation predicts persistent postpartum cardiac remodelling: A prospective cohort study and risk score development from Northeast Nigeria

Abstract

Background: Persistent postpartum cardiac remodelling increases peripartum cardiomyopathy risk, yet no antepartum risk tools exist for Sub-Saharan Africa. This study determined whether late-pregnancy metabolic profiles predict incomplete cardiac recovery at 5 months postpartum and developed a clinical risk score.

Materials and Methods: This prospective cohort study enrolled 120 women (60 normotensive and 60 hypertensive) at 36+ weeks of gestation in Bauchi, Nigeria. Fasting lipid and uric acid levels were measured at enrolment. Echocardiography was performed in late pregnancy and at 5 months postpartum. Persistent pathological remodelling was defined as left ventricular mass index >95 g/m² and/or diastolic dysfunction [early to late (atrial) ventricular filling velocity ratio <0.8 with E/e’ >8].

Results: Of the 120 participants, 115 (95.8%) completed the study. The hypertensive group had higher triglyceride levels (1.93 vs. 1.58 mmol/L; P = 0.012), lower high-density lipoprotein cholesterol (HDL-C) (1.15 vs. 1.35 mmol/L; P = 0.008) and elevated uric acid (352.8 vs. 298.6 μ mol/L; P < 0.001). Persistent remodelling occurred in 57.9% of hypertensive versus 20.7% of normotensive women (P < 0.001). Independent predictors were triglycerides ≥1.7 mmol/L [adjusted odds ratio (aOR) = 2.81], HDL-C < 1.2 mmol/L (aOR = 2.52) and uric acid ≥340 μ mol/L (aOR = 3.12). Remodelling prevalence was 15.8% (score 0), 42.2% (score 1) and 70.3% (scores 2–3); high-risk women had a relative risk of 4.45 (95% CI = 2.05–9.66).

Conclusion: Late-pregnancy metabolic dysregulation strongly predicts incomplete postpartum cardiac recovery. This simple, low-cost risk score enables antepartum stratification in resource-limited settings.