CV risk factors tied to adverse pregnancy outcomes, gestational diabetes, hypertension
CV risk factors were associated with adverse pregnancy outcomes and gestational diabetes, as well as hypertension 2 to 7 years after pregnancy, according to results of the nuMoM2b Heart Health Study.
“What we know about high blood pressure is that the earlier you have it, the worse your outcomes for heart disease can be. If we can change that course and intervene earlier, such as after a woman has an adverse pregnancy outcome, then we’re doing her a great service,” Victoria Pemberton, RNC, MS, nurse and researcher in the division of cardiovascular sciences at the NHLBI, said in a press release. “Typically, we think about women who are postmenopausal being at risk for heart disease. We don’t think about young women who are in their reproductive years or having babies being at risk for hypertension.”
The study, published in the Journal of the American Heart Association, included 4,471 young first-time pregnant women (mean age, 27 years). Researchers evaluated first trimester atherogenic markers for adverse pregnancy outcomes including hypertensive disorders of pregnancy, preterm birth and small for gestational age; gestational diabetes; and hypertension 2 to 7 years postpartum.
In the cohort, there were 1,102 women with adverse pregnancy outcomes and gestational diabetes. Compared with those without adverse pregnancy outcomes and gestational diabetes, women who had one or both were more likely to have obesity (34.2% vs. 19.5%), higher systolic BP (112.2 mm Hg vs. 108.4 mm Hg), higher diastolic BP (69.2 mm Hg vs. 66.6 mm Hg), higher glucose (5 mmol/L vs. 4.8 mmol/L), higher insulin (77.6 pmol/L vs. 60.1 pmol/L), higher triglycerides (1.4 mmol/L vs. 1.3 mmol/L), greater high-sensitivity C-reactive protein levels (5.6 nmol/L vs. 4 nmol/L) and lower HDL (1.8 mmol/L vs. 1.9 mmol/L; P < .05 for all).
After delivery, women with adverse pregnancy outcomes and gestational diabetes were more likely to develop hypertension compared with those without them (32.8% vs. 18.1%; P < .05), the researchers wrote.
Researchers observed an association between later hypertension 2 to 7 years postpartum and higher glucose (RR per 0.6 mmol/L = 1.03; 95% CI, 1-1.06), greater hsCRP (RR per twofold higher level = 1.06; 95% CI, 1.02-1.11) and higher triglycerides (RR per twofold higher level = 1.27; 95% CI, 1.14-1.41) after accounting for confounders and factors assessed antepartum. Higher levels of physical activity were protective against later hypertension (RR per 3 hours per week = 0.93; 95% CI, 0.87-0.99).
The 6.9% of women in the cohort who were not obese but had high lipid, hsCRP and insulin values had elevated risk for adverse pregnancy outcomes, gestational diabetes and postpartum hypertension, and 7% to 15% of their excess RR was associated with adverse pregnancy outcomes and gestational diabetes, the researchers wrote.
“During pregnancy, women are in frequent contact with care providers and participate in multiple medical screenings,” Janet M. Catov, PhD, researcher at the University of Pittsburgh Magee-Women’s Research Institute, said in the release. “A strong provider-patient partnership can be a first step in identifying potential risks for pregnancy complications while creating strategies to support the cardiovascular health of a mother and her child for years to come.”