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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
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Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 1

Category: Hypertension

Poster Session 1

(270) Under Pressure: Exploring Relationships between Hypertensive Disorders of Pregnancy and Abnormal Aortic and Valvular Anatomy

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  
Objective:
Abnormal aortic morphology predisposes to hypertensive disorders of pregnancy (HDP). However, bicuspid aortic valve (BAV) with or without aortopathy has not been characterized as a risk for HDPs. We investigate the degree of and change in aortic diameter in pregnant people with BAV and the association of these parameters with HDPs.

Study Design:
Pregnancies in people with BAV from 2012-2025 in an academic Cardio-Obstetrics program were identified by ICD codes. Pregnancies were excluded if patients had prior aortic valve surgery or incomplete records. Clinical outcomes and echocardiographic parameters were abstracted. Random forest modeling and bootstrapped logistic regression simulated effect sizes in the setting of rare outcomes. Occurrence of an HDP was modeled with respect to patient age, aortic dilation (< or >4cm), anatomic location of dilation, and progression of aortic dilation (< or > 3mm) over pregnancy.

Results:
73 patients and 100 pregnancies were reviewed, 23 experienced an HDP (Table 1). 80 pregnancies had > 1 ECHO. 21.3% (N=17) demonstrated aortic dilation >4cm, with 10.0% (N=8) showing progression through pregnancy. The ascending aorta was the most common location for abnormal dilation (N=39, 48.8%). In predicting an HDP, patient age was the most important factor, followed by the presence of abnormal aortic dilation (Figure 1 top); the location of and change in dilation over pregnancy did not contribute. Both progression and degree of dilation were unevenly distributed by HDP-type (Figure 1 bottom), with severe forms of disease being disproportionately represented in those with expanding and abnormally dilated aortas. In a bootstrapped regression model predicting severe HDP, abnormal dilation was a significant predictor (absolute risk increase of 0.11, P=0.02). Progressive dilation was not a significant predictor of severe HDP (P=0.08).

Conclusion:

Having a dilated aorta with BAV is independently associated with severe HDP occurrence. Risk mitigation strategies should be considered in this population even in the absence of classic HDP risk factors.