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Early Pregnancy Atherogenic Profile in a First Pregnancy and Hypertension Risk 2 to 7 Years After Delivery.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2021 Feb; Vol. 10 (5), pp. e017216. Date of Electronic Publication: 2021 Feb 23. - Publication Year :
- 2021
-
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 (hypertensive 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. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02231398.
- Subjects :
- Adult
Female
Humans
Infant, Newborn
Pregnancy
Follow-Up Studies
Incidence
Pregnancy Outcome
Retrospective Studies
Risk Factors
Time Factors
United States epidemiology
Atherosclerosis blood
Atherosclerosis epidemiology
Atherosclerosis etiology
Biomarkers blood
Blood Pressure physiology
Diabetes, Gestational blood
Diabetes, Gestational epidemiology
Diabetes, Gestational physiopathology
Hypertension complications
Hypertension epidemiology
Hypertension physiopathology
Pregnancy Complications, Cardiovascular blood
Pregnancy Complications, Cardiovascular epidemiology
Pregnancy Complications, Cardiovascular physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 10
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 33619977
- Full Text :
- https://doi.org/10.1161/JAHA.120.017216