Abstract
BACKGROUND: Cardiovascular risk in young adulthood is an important determinant of lifetime cardiovascular disease risk. Women with adverse pregnancy outcomes (APOs) have increased cardiovascular risk, but the relationship of other factors is unknown. METHODS AND RESULTS: Among 4471 primiparous women, we related first-trimester atherogenic markers to risk of APO (hyper-tensive disorders of pregnancy, preterm birth, small for gestational age), gestational diabetes mellitus (GDM) and hypertension (130/80 mm Hg or antihypertensive use) 2 to 7 years after delivery. Women with an APO/GDM (n=1102) had more atherogenic characteristics (obesity [34.2 versus 19.5%], higher blood pressure [systolic blood pressure 112.2 versus 108.4, diastolic blood pressure 69.2 versus 66.6 mm Hg], glucose [5.0 versus 4.8 mmol/L], insulin [77.6 versus 60.1 pmol/L], triglycerides [1.4 versus 1.3 mmol/L], and high-sensitivity C-reactive protein [5.6 versus 4.0 nmol/L], and lower high-density lipoprotein cholesterol [1.8 versus 1.9 mmol/L]; P<0.05) than women without an APO/GDM. They were also more likely to develop hypertension after delivery (32.8% versus 18.1%, P<0.05). Accounting for confounders and factors routinely assessed antepartum, higher glucose (relative risk [RR] 1.03 [95% CI, 1.00–1.06] per 0.6 mmol/L), high-sensitivity C-reactive protein (RR, 1.06 [95% CI, 1.02–1.11] per 2-fold higher), and triglycerides (RR, 1.27 [95% CI, 1.14–1.41] per 2-fold higher) were associated with later hypertension. Higher physical activity was protective (RR, 0.93 [95% CI, 0.87-0.99] per 3 h/week). When evaluated as latent profiles, the nonobese group with higher lipids, high-sensitivity C-reactive protein, and insulin values (6.9% of the cohort) had increased risk of an APO/GDM and later hypertension. Among these factors, 7% to 15% of excess RR was related to APO/GDM. CONCLUSIONS: Individual and combined first-trimester atherogenic characteristics are associated with APO/GDM occurrence and hypertension 2 to 7 years later.
Original language | English (US) |
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Article number | e017216 |
Pages (from-to) | 1-33 |
Number of pages | 33 |
Journal | Journal of the American Heart Association |
Volume | 10 |
Issue number | 5 |
DOIs | |
State | Published - 2021 |
Funding
This study is supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10 HD063036, U10 HD063072, U10 HD063047, U10 HD063037, U10 HD063041, U10 HD063020, U10 HD063046, U10 HD063048, and U10 HD063053. The study is also supported by cooperative agreement funding from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10-HL119991, U10-HL119989, U10-HL120034, U10-HL119990, U10-HL120006, U10-HL119992, U10-HL120019, U10-HL119993, U10-HL120018, and U01HL145358. Support was also provided by the National Institutes of Health Office of Research on Women’s Health through U10-HL-119991, Office of Behavioral and Social Sciences Research through U10-HL119991 and U10-HL119992, National Center for Advancing Translational Sciences through UL-1-TR000124, UL-1-TR000153, UL-1-TR000439, and UL-1-TR001108; and the Barbra Streisand Women’s Cardiovascular Research and Education Program, and the Erika J. Glazer Women’s Heart Research Initiative, Cedars-Sinai Medical Center, Los Angeles. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the US Department of Health and Human Services. This study is supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10 HD063036, U10 HD063072, U10 HD063047, U10 HD063037, U10 HD063041, U10 HD063020, U10 HD063046, U10 HD063048, and U10 HD063053. The study is also supported by cooperative agreement funding from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10-HL119991, U10-HL119989, U10-HL120034, U10-HL119990, U10-HL120006, U10-HL119992, U10-HL120019, U10-HL119993, U10-HL120018, and U01HL145358. Support was also provided by the National Institutes of Health Office of Research on Women?s Health through U10-HL-119991, Office of Behavioral and Social Sciences Research through U10-HL119991 and U10-HL119992, National Center for Advancing Translational Sciences through UL-1-TR000124, UL-1-TR000153, UL-1-TR000439, and UL-1-TR001108; and the Barbra Streisand Women?s Cardiovascular Research and Education Program, and the Erika J. Glazer Women?s Heart Research Initiative, Cedars-Sinai Medical Center, Los Angeles. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the US Department of Health and Human Services.
Keywords
- high blood pressure ■ hypertension ■ lipids ■ preeclampsia/pregnancy ■ pregnancy and postpartum
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine