Obesity before, during pregnancy leading cause of later heart disease
Click Here to Manage Email Alerts
Key takeaways:
- Early and prepregnancy BMI is a predictor of adverse pregnancy outcomes, which are associated with CVD risk.
- Obesity intervention before pregnancy is key.
Data show overweight or obesity before or during early pregnancy is a strong predictor of adverse pregnancy outcomes that influence postpartum CVD, underscoring the need for counseling about excess weight.
“We know that certain pregnancy complications are associated with not only higher risk for CVD but also earlier onset,” Sadiya Sana Khan, MD, MSc, FACC, FAHA, associate professor of medicine and preventive medicine, associate program director of the cardiovascular disease fellowship and director of research in the section of heart failure at Northwestern University Feinberg School of Medicine, told Healio. “Therefore, we wanted to ask the question: Are the pregnancy complications the ‘trigger’ causing risk in later life or are they ‘unmasking’ risk that already exists?”
Image: Adobe Stock
Khan and colleagues analyzed data from 4,216 adults participating in the nuMoM2b Heart Health Study who were enrolled during their first trimester from eight U.S. sites. The mean age of participants was 28 years; follow-up took place at 3.7 years postpartum. Adverse pregnancy outcomes, which included hypertensive disorders of pregnancy, preterm birth, small for gestational age birth and gestational diabetes, were centrally adjudicated. Researchers conducted mediation analyses to estimate the association between early pregnancy BMI and postpartum CVD risk factors, including hypertension, hyperlipidemia and type 2 diabetes and the proportion mediated by each adverse pregnancy outcome. Researchers adjusted the findings for demographics and baseline health behaviors, psychosocial stressors and CVD risk-factor levels.
The findings were published in Circulation Research.
Witihn the cohort, 25% of participants had early pregnancy overweight and 22% had early pregnancy obesity.
Hypertensive disorders of pregnancy occurred in 15% of women, preterm birth in 8%, small for gestational age birth in 11% and gestational diabetes in 4%.
Compared with normal BMI, early pregnancy obesity was associated with a higher incidence of postpartum hypertension (adjusted OR = 1.14; 95% CI, 1.1-1.18), hyperlipidemia (aOR = 1.11; 95% CI, 1.08-1.14) and diabetes (aOR = 1.03; 95% CI, 1.01-1.04), with results persisting after adjustment for baseline CVD risk-factor levels. Adverse pregnancy outcomes were associated with higher incidence of postpartum hypertension (aOR = 1.97; 95% CI, 1.61-2.4) and hyperlipidemia (aOR = 1.31; 95% CI, 1.03-1.67).
Hypertensive disorders of pregnancy mediated a small proportion of the association between obesity and incident hypertension (13%) and did not mediate associations with incident hyperlipidemia or diabetes. There was no significant mediation by preterm birth or small for gestational age birth.
“These findings underscore the importance of prioritizing and promoting cardiovascular health in young adults before and during pregnancy,” Khan told Healio. “We often are counseling people on a variety of things related to pregnancy at the first prenatal visit (like prenatal vitamins) that have made a huge impact on outcomes but we need to incorporate counseling for cardiovascular health when someone is considering pregnancy or early in prenatal visits.”
Khan said clinicians should also carefully follow women with excess weight postpartum to ensure risk factors are managed before and between subsequent pregnancies.
“In other work published by our group earlier this year in JAMA, we highlighted that only 60% of individuals received counseling on healthy eating, exercise and losing weight gained during pregnancies,” Khan said. “This is important not only for their health but also for subsequent pregnancies.”
For more information:
Sadiya Sana Khan, MD, MSc, FACC, FAHA, can be reached at s-khan-1@northwestern.edu; X (Twitter): @HeartDocSadiya.
Collapse
Read more about
Click Here to Manage Email Alerts