Abstract
OBJECTIVE:To examine the association between elevated blood pressure (BP) in the early third trimester and cardiometabolic health 10-14 years after delivery.METHODS:This is a secondary analysis from the prospective HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study). Blood pressure in the early third trimester was categorized per American College of Cardiology/American Heart Association thresholds for: normal BP below 120/80 mm Hg (reference), elevated BP 120-129/below 80 mm Hg, stage 1 hypertension 130-139/80-89 mm Hg, and stage 2 hypertension 140/90 mm Hg or higher. Cardiometabolic outcomes assessed 10-14 years after the index pregnancy were type 2 diabetes mellitus and measures of dyslipidemia, including low-density lipoprotein (LDL) cholesterol 130 mg/dL or higher, total cholesterol 200 mg/dL or higher, high-density lipoprotein (HDL) cholesterol 40 mg/dL or lower, and triglycerides 200 mg/dL or higher. Adjusted analysis was performed with the following covariates: study field center, follow-up duration, age, body mass index (BMI), height, family history of hypertension and diabetes, smoking and alcohol use, parity, and oral glucose tolerance test glucose z score.RESULTS:Among 4,692 pregnant individuals at a median gestational age of 27.9 weeks (interquartile range 26.6-28.9 weeks), 8.5% (n=399) had elevated BP, 14.9% (n=701) had stage 1 hypertension, and 6.4% (n=302) had stage 2 hypertension. At a median follow-up of 11.6 years, among individuals with elevated BP, there was a higher frequency of diabetes (elevated BP: adjusted relative risk [aRR] 1.88, 95% CI, 1.06-3.35; stage 1 hypertension: aRR 2.58, 95% CI, 1.62-4.10; stage 2 hypertension: aRR 2.83, 95% CI, 1.65-4.95) compared with those with normal BP. Among individuals with elevated BP, there was a higher frequency of elevated LDL cholesterol (elevated BP: aRR 1.27, 95% CI, 1.03-1.57; stage 1 hypertension: aRR 1.22, 95% CI, 1.02-1.45, and stage 2 hypertension: aRR 1.38, 95% CI, 1.10-1.74), elevated total cholesterol (elevated BP: aRR 1.27, 95% CI, 1.07-1.52; stage 1 hypertension: aRR 1.16, 95% CI, 1.00-1.35; stage 2 hypertension: aRR 1.41 95% CI, 1.16-1.71), and elevated triglycerides (elevated BP: aRR 2.24, 95% CI, 1.42-3.53; stage 1 hypertension: aRR 2.15, 95% CI, 1.46-3.17; stage 2 hypertension: aRR 3.24, 95% CI, 2.05-5.11) but not of low HDL cholesterol.CONCLUSION:The frequency of adverse cardiometabolic outcomes at 10-14 years after delivery was progressively higher among pregnant individuals with BP greater than 120/80 in the early third trimester.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 395-402 |
| Number of pages | 8 |
| Journal | Obstetrics and gynecology |
| Volume | 144 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2024 |
Funding
HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study) was conducted by the HAPO FUS Investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the American Diabetes Association. The HAPO Study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and American Diabetes Association. The data from the HAPO FUS reported here were supplied by the NIDDK Central Repository. This manuscript was prepared in collaboration with some of the investigators of the HAPO FUS and does not necessarily reflect the opinions or views of the HAPO FUS, the NIDDK Central Repository, or the NIDDK. Dr. Venkatesh was supported by the Care Innovation and Community Improvement Program at The Ohio State University. Dr Khan was supported by National Heart, Lung, and Blood Institute grant HL161514.
ASJC Scopus subject areas
- Obstetrics and Gynecology
