Introduction
The maternal heart and circulation undergo dramatic remodelling throughout the three trimesters of pregnancy and postpartum in response to the burden of gestation. Pregnancy complications contribute to long-term heart failure risks in the mother [1]. The relationship between physiological changes in cardiac loading, ionic remodelling, wall thickness, and posture with ECG and pressure-volume biomarkers remains unclear.
Materials and Methods
Model construction and validation data were extracted from the literature [2] including ionic remodelling, haemodynamic changes, and anatomical and postural changes to the heart for three trimesters of pregnancy and postpartum. ECG and strain biomarkers were used to validate the model predictions.
Building upon a validated baseline human multi-scale electromechanical biventricular model [3], we use female-specific anatomy and electrophysiology as baseline and apply pregnancy-specific changes to anatomy and function, and compare model predicted ECG and strain outcomes to literature values.
One-at-a-time sensitivity analysis of key model parameters was performed at each stage in the pregnancy timeline to determine the key multi-scale determinants of clinical biomarkers in pregnancy.
Results
Simulations incorporating pregnancy haemodynamic and ionic changes show expected directional shifts in EDV, peak systolic pressure, QRS duration, and QT interval biomarkers consistent with the literature. Full results across the pregnancy and postpartum timeline, including sensitivity analyses identifying key determinants of ECG and functional changes at each stage, will be presented at the conference.
Discussion and Conclusions
Multi-scale electromechanical model of the maternal heart across the full pregnancy and postpartum timeline shows insights on the relative contributions of ionic, haemodynamic, and anatomical remodelling on clinically measurable biomarkers. This work lays the groundwork for Digital Twins for maternity cardiac care.
References
1. Boardman et al. Hypertension 75:1542–1550 (2020)
2. Agarwal et al. Front. Cardiovasc. Med. (2024)
3. Wang et al. eLife 14, (2025)