Fetal cardiac function and doppler parameters in relation to preeclampsia severity and neonatal outcomes

To evaluate the associations between preeclampsia severity and fetal cardiac function and Doppler parameters and to explore the discrimination of individual parameters for severe preeclampsia and neonatal intensive care unit (NICU) admission within the study cohort. This prospective, single-center observational study included 224 women with preeclampsia, classified as non-severe ( n = 150) or severe preeclampsia ( n = 74). Fetal cardiovascular assessment included the Tei index, isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT), ejection time (ET), umbilical artery pulsatility index (UA PI), pulmonary artery pulsatility index (PA PI), and pulmonary artery peak systolic velocity (PA PSV). Separate multivariable linear regression analyses were performed for each parameter, adjusting for gestational age at fetal assessment, maternal age, and body mass index. Sensitivity analyses additionally accounted for early-onset preeclampsia and fetal growth restriction. Exploratory receiver operating characteristic analyses assessed the cohort-specific discrimination of individual parameters. Compared with the non-severe group, women with severe preeclampsia had higher Tei index, IVCT, IVRT, UA PI, and PA PI and lower ET and PA PSV (all p < 0.001). All associations remained statistically significant after adjustment for gestational age at fetal assessment, maternal age, and body mass index and in sensitivity analyses additionally accounting for early-onset preeclampsia and fetal growth restriction (all p < 0.001). The severe preeclampsia group also had earlier delivery, lower birth weight and 5-minute Apgar scores, and more frequent NICU admission (23.0% vs. 5.3%, p < 0.001). In exploratory ROC analyses, IVRT showed the highest cohort-specific discrimination for severe preeclampsia (AUC, 0.861; 95% CI, 0.81–0.91), followed by the Tei index (AUC, 0.849; 95% CI, 0.79–0.90). Discrimination for NICU admission was limited, with the highest AUC observed for the Tei index (0.650). In this cohort, severe preeclampsia was associated with altered fetal cardiac function and Doppler parameters after adjustment for gestational age at fetal assessment, maternal age, and body mass index. Similar findings were observed in sensitivity analyses additionally accounting for early-onset preeclampsia and fetal growth restriction, although residual confounding cannot be excluded. The ROC findings represent exploratory, cohort-specific measures of discrimination and should not be interpreted as validated evidence of clinical utility. Given the observational design, these findings do not establish causality. Further multicenter studies are required to confirm these associations, and internal and external validation is needed to assess the reproducibility and potential clinical relevance of the ROC findings.