Poor Prepregnancy Cardiovascular Health tied to Midlife Heart Risk, Independent of Gestational Diabetes: JAMA

The exposure of interest was cardiovascular health pre-pregnancy, which was quantified using the American Heart Association's Life's Simple 7 scoring system, which incorporates aspects such as diet, physical activity, blood pressure, and cholesterol. The scores range from 0 to 14, with higher scores reflecting improved heart health. Researchers segregated participants into two categories: low to moderate CVH (scores 0–10) and high CVH (scores 11–14). The primary outcome was the presence of coronary artery calcium (CAC), a subclinical atherosclerosis marker, identified by CT scans between the 15–25-year follow-up period. The analysis controlled for age, race, education, and parity, and was supplemented with mediation modeling to calculate the proportion of the CVH-CAC relationship that was explained by gestational diabetes.

Results

• Participants' average age was 28.6 years, and almost half (47.6%) were Black and 52.4% were White.

• Women with a lower CVH prior to pregnancy had higher rates of GD (8.8%) than those with high CVH (6.3%).

• They were also at greater odds of exhibiting CAC in midlife: 28.2% with low/moderate CVH exhibited CAC compared with 19.2% with high CVH.

• The adjusted odds ratio for the development of GD in women with poor CVH was 1.8 (95% CI: 1.1–3.0), and for the development of CAC, 1.7 (95% CI: 1.2–2.5).

• Nonetheless, GD accounted for only 6% of the augmented risk of CAC (95% CI: 0%–22%), indicating that it is not the principal cause of midlife CVD in this population.

Overall, this large, long-term study demonstrates that poor prepregnancy cardiovascular health is highly predictive of the presence of subclinical heart disease in later life, though not substantially mediated through gestational diabetes.

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