TY - JOUR
T1 - Prepregnancy Adiposity, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk in Midlife
AU - Borrowman, Jaclyn D.
AU - Huang, Xiaoning
AU - Petito, Lucia C.
AU - Perak, Amanda M.
AU - Scholtens, Denise
AU - Lowe, William J.
AU - Lloyd-Jones, Donald M
AU - Grobman, William A
AU - Khan, Sadiya S.
N1 - Publisher Copyright:
© 2025 American College of Cardiology Foundation
PY - 2025/4/22
Y1 - 2025/4/22
N2 - Background: Prepregnancy obesity is a key modifiable risk factor for both adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD). However, whether APOs represent a marker or mediator between body mass index (BMI) and CVD risk is unclear. Objectives: This study sought to determine the extent to which the association between prepregnancy BMI and CVD risk factors in midlife is mediated by APOs. Methods: Pregnant participants aged ≥18 years enrolled at 28 weeks’ gestation (range: 24-32 weeks) in the HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcomes Follow-Up Study) without prepregnancy hypertension or diabetes were included in analyses. Participants had a follow-up visit 11.6 ± 1.3 years after delivery. Mediation analysis assessed the proportion of the association between self-reported prepregnancy BMI and CVD risk factors at follow-up (mean arterial pressure [MAP], triglycerides, and hemoglobin A1c [HbA1c]) mediated by gestational diabetes (GDM) and new-onset hypertensive disorders of pregnancy (HDP). Analyses were adjusted for maternal and gestational age, parity, field center, alcohol and smoking status in pregnancy, and fetal sex. Results: Among 4,269 study participants, mean maternal age was 30.1 ± 5.6 years, and 10.6% had prepregnancy obesity. GDM and new-onset HDP occurred in 13.8% and 10.7% of participants, respectively. Compared with those with a normal prepregnancy BMI, those with prepregnancy obesity had higher MAP (7.0 mm Hg; 95% CI: 6.0-8.1 mm Hg), triglycerides (28.5 mg/dL; 95% CI: 21.9-35.1 mg/dL), and HbA1c (0.3%; 95% CI: 0.2%-0.4%) at follow-up at a mean age of 41.7 ± 5.6 years. GDM partially mediated the association between obesity and HbA1c (24.6%; 95% CI: 20.9%-28.4%), whereas new-onset HDP partially mediated the association between obesity and MAP (12.4%; 95% CI: 10.6%-14.2%). Conclusions: In this multinational cohort of pregnant individuals, APOs mediated a small proportion of the association between prepregnancy obesity and CVD risk in mid-life. Prioritizing weight management earlier in the life course before pregnancy may promote maternal and midlife cardiovascular health.
AB - Background: Prepregnancy obesity is a key modifiable risk factor for both adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD). However, whether APOs represent a marker or mediator between body mass index (BMI) and CVD risk is unclear. Objectives: This study sought to determine the extent to which the association between prepregnancy BMI and CVD risk factors in midlife is mediated by APOs. Methods: Pregnant participants aged ≥18 years enrolled at 28 weeks’ gestation (range: 24-32 weeks) in the HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcomes Follow-Up Study) without prepregnancy hypertension or diabetes were included in analyses. Participants had a follow-up visit 11.6 ± 1.3 years after delivery. Mediation analysis assessed the proportion of the association between self-reported prepregnancy BMI and CVD risk factors at follow-up (mean arterial pressure [MAP], triglycerides, and hemoglobin A1c [HbA1c]) mediated by gestational diabetes (GDM) and new-onset hypertensive disorders of pregnancy (HDP). Analyses were adjusted for maternal and gestational age, parity, field center, alcohol and smoking status in pregnancy, and fetal sex. Results: Among 4,269 study participants, mean maternal age was 30.1 ± 5.6 years, and 10.6% had prepregnancy obesity. GDM and new-onset HDP occurred in 13.8% and 10.7% of participants, respectively. Compared with those with a normal prepregnancy BMI, those with prepregnancy obesity had higher MAP (7.0 mm Hg; 95% CI: 6.0-8.1 mm Hg), triglycerides (28.5 mg/dL; 95% CI: 21.9-35.1 mg/dL), and HbA1c (0.3%; 95% CI: 0.2%-0.4%) at follow-up at a mean age of 41.7 ± 5.6 years. GDM partially mediated the association between obesity and HbA1c (24.6%; 95% CI: 20.9%-28.4%), whereas new-onset HDP partially mediated the association between obesity and MAP (12.4%; 95% CI: 10.6%-14.2%). Conclusions: In this multinational cohort of pregnant individuals, APOs mediated a small proportion of the association between prepregnancy obesity and CVD risk in mid-life. Prioritizing weight management earlier in the life course before pregnancy may promote maternal and midlife cardiovascular health.
KW - adverse pregnancy outcomes
KW - cardiovascular health
KW - midlife
KW - obesity
KW - pregnancy
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U2 - 10.1016/j.jacc.2025.02.033
DO - 10.1016/j.jacc.2025.02.033
M3 - Article
C2 - 40240091
AN - SCOPUS:105001715467
SN - 0735-1097
VL - 85
SP - 1536
EP - 1546
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 15
ER -
