Cardiovascular Determinants Of Preterm Birth: A Chinese Cohort Study

Medical Science

Background: Maternal cardiovascular dysfunction is increasingly recognized as a contributor to preterm birth, yet specific determinants—particularly pulmonary regurgitation (PR) and composite cardiovascular risk scores—remain inadequately characterized, especially in Asian populations. Objective: To identify associations between cardiovascular parameters and preterm delivery, evaluate the performance of a novel Composite Cardiovascular Dysfunction Score (CCDS), and examine independent contributions of hemodynamic and metabolic factors. Methods: This retrospective cohort study included pregnant women referred for cardiovascular assessment at a tertiary center in China. Comprehensive echocardiography, serum BNP, and hemodynamic measurements were obtained at referral. A cumulative valvular burden score (0–4) and CCDS (integrating BNP, ejection fraction, and valvular disease) were constructed. Multivariable logistic regression and ROC analyses were performed. Results: Among 71 women (49 preterm, 22 term), pulmonary regurgitation was strongly associated with preterm delivery (OR 5.81; 95% CI 1.21–27.78; p=0.022). Preterm delivery was also associated with significantly lower mean ejection fraction (56.8% vs. 61.2%; mean difference –4.4%; p=0.021). Trends toward higher mean arterial pressure (p=0.061), elevated systemic vascular resistance (p=0.062), and obesity (p=0.076) were observed. The CCDS demonstrated modest discriminatory ability (AUC 0.659; 95% CI 0.525–0.793); a score ≥7.0 yielded 67.3% sensitivity and 78.6% PPV. All seven women in the very high-risk category (9–10 points) delivered preterm (p=0.077). Each 1-point CCDS increase was associated with 28–33% higher odds of preterm delivery across multivariable models. Conclusion: Pulmonary regurgitation is a novel, independent risk factor for preterm delivery, challenging the conventional classification of regurgitant lesions as uniformly low-risk in pregnancy. Subtle systolic dysfunction and integrated cardiovascular burden contribute to preterm birth risk. These findings support comprehensive cardiovascular phenotyping in at-risk pregnancies and provide the first evidence from a Chinese cohort.

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