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Introduction Hypertensive disorders and poor dietary quality are associated with increased long-term risk of cardiovascular and metabolic disease. Energy intake patterns after hypertensive (HP) versus normotensive pregnancy (NP) may provide insight into these risk associations and their mechanisms. Objective/hypothesis Assess diet quality as measured by micronutrient and macronutrient intake six months after NP versus HP (either preeclampsia or gestational hypertension). Methods Prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatrics) study. Women were studied 6 months after NP versus HP. Energy intake (EI) was measured using a self-reported, three-day food diary and FoodWorksTM to calculate macronutrient and micronutrient intake. Results 74 women (60 NP, 14 HP) had complete, analysable 3-day food diaries 6 months postpartum. Maternal age (32 NP, 31 HP) was similar, however less (4/14; 29%) of the HP group were still breastfeeding (50/60; 83% of NP, p 0.001). Mean BMI was higher postpartum in HP (29 ± 8 versus 24 ± 4, p =0.02). Total average EI was 17% lower in HP (7909kJ versus 9534kJ NP, p = 0.02). Macronutrient intake (carbohydrate, fat and protein) was similar between groups. However, intake of several important micronutrients was significantly lower after HP, even allowing for the lower total EI, including Vitamin A (43% lower), riboflavin (36% lower), magnesium (34%), calcium (29%), iodine (29%) and phosphorus (24%). Women breastfeeding at 6 months (both after NP and HP, n=54) had higher carbohydrate and fat (but not protein) intake compared to women not breastfeeding (n=20), and also increased intake of Vitamin A, riboflavin, magnesium and iron. However, breastfeeding women also had higher EI, with their increased macronutrient and micronutrient intake approximately in proportion to their overall EI versus women not breastfeeding. Discussion Six months postpartum, women with previous HP have significantly lower reported micronutrient intake compared to NP, possibly reflecting poorer diet quality.

Introduction Gestational hypertensive disorders (GHD), such as gestational hypertension (GH) and pre-eclampsia (PE), are risk factors for cardiovascular disease (CVD) in later life. Although the exact underlying mechanisms are not clear, changes in the microcirculation have also been proposed as a potential pathway in the development of CVD. Objective We examined whether a history of GHD is related to the maternal status of the microcirculation after pregnancy, as visualized by retinal imaging. Methods This study was embedded in the Generation R Study, a population-based prospective cohort study. Data on pregnancy, including GHD, and retinal vessel calibers six years after pregnancy were available for 3391 women. Retinal arteriolar and venular calibers were measured unilaterally from digitalized retinal photographs. Results Women with a history of PE had smaller retinal arteriolar calibers than women with a normotensive pregnancy (age-adjusted difference: −0.49SDS; 95% confidence interval (CI) −0.74, −0.25)). Additional adjustment for retinal venular caliber, ethnicity, educational level, smoking and pre-pregnancy BMI did not alter these results. After including mean arterial blood pressure at the time of retinal imaging, the association attenuated (−0.22SDS; 95% CI −0.43, −0.01), but remained significant. For women with a history of GH similar trends were observed, which disappeared after including mean arterial blood pressure at the time of retinal imaging in the model (−0.001SDS; 95% CI −0.14, 0.14). With respect to retinal venular calibers, we did not observe consistent trends for women with a history of PE. However, in women with a history of GH we observed larger venular calibers (multi-variable adjusted 0.16SDS; 95% CI 0.01, 0.31) than in women with a previous normotensive pregnancy. Conclusions Women with a history of GHD show an altered state of the microcirculation as reflected by smaller retinal arteriolar vessel calibers and larger retinal venular calibers six years after index pregnancy. These microvascular changes may contribute to the development of CVD in later life.

Introduction Increased body fat is associated with detrimental metabolic outcomes, however it is unclear whether there are differences in body composition in postpartum women after normotensive/uncomplicated pregnancy (NP) versus hypertensive pregnancy (HTP). Objectives To determine differences in body composition and energy metabolism six months postpartum in women who had a normotensive versus hypertensive pregnancy. We hypothesised that there would be a higher percent body fat (BF%), and altered energy intake (EI) and total energy expenditure (TEE) in women after hypertensive versus normotensive pregnancy. Methods Body composition (BF%, lean body mass – LBM) and energy metabolism (EI and TEE) were measured 6 months postpartum in NP women ( n = 42) and HTP women ( n = 14). Women were recruited from the longitudinal P4 study (2013-ongoing) at St George Hospital, Sydney. BF% and LBM were measured using multi-frequency bio-impedance analysis. TEE was measured using the SenseWear Armband, worn over 24 h. This also measures metabolic equivalents (MET’s): the energy cost of a physical activity. Finally, EI was measured using a three-day food recall diary and analysed using Foodworks. Results There are significant differences in body composition and energy balance between healthy and hypertensive women at 6 months postpartum (Table). HTP women had a higher BMI ( p = 0.02) and on average 5% more body fat than NP women ( p = 0.03), whilst LBM was similar between groups. There was no significant difference in EI between groups. TEE was similar between groups, but average METs were significantly lower in the hypertensive group ( p = 0.03). Conclusion Six months postpartum, women who had hypertension in pregnancy have a higher BMI and more body fat than women with normotensive pregnancy. MET results show that previously hypertensive women metabolise less energy for a given physical activity compared to healthy women. This suggests a change in metabolic state, involving increased metabolic efficiency and energy conservation. Six months postpartum may be an important time for identification and potential intervention to alter maternal risk profiles and negative long-term trajectory for women with hypertensive disorders of pregnancy. Patient demographics, body composition and energy balance 6 months after normotensive versus hypertensive pregnancy.