Abstract
Background: The American Heart Association's formal characterization of cardiovascular health combines several metrics in a health-oriented, rather than disease-oriented, framework. Although cardiovascular health assessment during pregnancy has been recommended, its significance for pregnancy outcomes is unknown. Objective: The purpose of this study was to examine the association of gestational cardiovascular health—formally characterized by a combination of 5 metrics—with adverse maternal and newborn outcomes. Study Design: We analyzed data from the Hyperglycemia and Adverse Pregnancy Outcome study, including 2304 mother-newborn dyads from 6 countries. Maternal cardiovascular health was defined by the combination of the following 5 metrics measured at a mean of 28 (24–32) weeks’ gestation: body mass index, blood pressure, lipids, glucose, and smoking. Levels of each metric were categorized using pregnancy guidelines, and the total cardiovascular health was scored (0–10 points, where 10 was the most favorable). Cord blood was collected at delivery, newborn anthropometrics were measured within 72 hours, and medical records were abstracted for obstetrical outcomes. Modified Poisson and multinomial logistic regression were used to test the associations of gestational cardiovascular health with pregnancy outcomes, adjusted for center and maternal and newborn characteristics. Results: The average age of women at study exam was 29.6 years old, and they delivered at a mean gestational age of 39.8 weeks. The mean total gestational cardiovascular health score was 8.6 (of 10); 36.3% had all ideal metrics and 7.5% had 2+ poor metrics. In fully adjusted models, each 1 point higher (more favorable) cardiovascular health score was associated with lower risks for preeclampsia (relative risk, 0.67 [95% confidence interval, 0.61–0.73]), unplanned primary cesarean delivery (0.88 [0.82–0.95]), newborn birthweight >90th percentile (0.81 [0.75–0.87]), sum of skinfolds >90th percentile (0.84 [0.77–0.92]), and insulin sensitivity <10th percentile (0.83 [0.77–0.90]). Cardiovascular health categories demonstrated graded associations with outcomes; for example, relative risks (95% confidence intervals) for preeclampsia were 3.13 (1.39–7.06), 5.34 (2.44–11.70), and 9.30 (3.95–21.86) for women with ≥1 intermediate, 1 poor, or ≥2 poor (vs all ideal) metrics, respectively. Conclusion: More favorable cardiovascular health at 24 to 32 weeks’ gestation was associated with lower risks for several adverse pregnancy outcomes in a multinational cohort.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 210.e1-210.e17 |
| Journal | American journal of obstetrics and gynecology |
| Volume | 224 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2021 |
Funding
The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was funded by grants R01HD34242 and R01HD34243 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development , with additional HAPO ancillary study data obtained through grants R01DK095963 and R01DK117491 from the National Institute of Diabetes and Digestive and Kidney Diseases . The ancillary cardiovascular health study was funded by a Dixon Translational Research grant from the Northwestern University Clinical and Translational Sciences Institute and the Northwestern Memorial Foundation , an Eleanor Wood-Prince grant from the Woman’s Board of Northwestern Memorial Hospital, and a subcontract under grant 17SFRN33660752 from the American Heart Association . The research reported in this article was supported, in part, by grant UL1TR001422 from the National Center for Advancing Translational Sciences, National Institutes of Health . A.M.P. was supported by grant K23HL145101 from the National Heart, Lung, and Blood Institute and the Pediatric Physician-Scientist Research Award from the Department of Pediatrics, Northwestern University Feinberg School of Medicine . This study was also supported, in part, by grants 17SFRN33660752 (D.R.L.), 17SFRN33700101 (D.R.L., N.B.A., and D.M.L.J.), and 17SFRN33700155 (S.H.S.) from the American Heart Association. The funding sources had no role in the study design; collection, analysis, or interpretation of data; writing of the report; or the decision to submit the article for publication. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was funded by grants R01HD34242 and R01HD34243 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with additional HAPO ancillary study data obtained through grants R01DK095963 and R01DK117491 from the National Institute of Diabetes and Digestive and Kidney Diseases. The ancillary cardiovascular health study was funded by a Dixon Translational Research grant from the Northwestern University Clinical and Translational Sciences Institute and the Northwestern Memorial Foundation, an Eleanor Wood-Prince grant from the Woman's Board of Northwestern Memorial Hospital, and a subcontract under grant 17SFRN33660752 from the American Heart Association. The research reported in this article was supported, in part, by grant UL1TR001422 from the National Center for Advancing Translational Sciences, National Institutes of Health. A.M.P. was supported by grant K23HL145101 from the National Heart, Lung, and Blood Institute and the Pediatric Physician-Scientist Research Award from the Department of Pediatrics, Northwestern University Feinberg School of Medicine. This study was also supported, in part, by grants 17SFRN33660752 (D.R.L.), 17SFRN33700101 (D.R.L., N.B.A., and D.M.L.J.), and 17SFRN33700155 (S.H.S.) from the American Heart Association. The funding sources had no role in the study design; collection, analysis, or interpretation of data; writing of the report; or the decision to submit the article for publication.
Keywords
- adiposity
- birthweight
- blood pressure
- body mass index
- cesarean delivery
- gestational diabetes
- glucose
- insulin resistance
- preeclampsia
- smoking
- triglycerides
ASJC Scopus subject areas
- Obstetrics and Gynecology
