Study reveals Long-Term Impact of Adverse Pregnancy Outcomes on Cardiovascular Health

Recent research paper aimed to investigate the potential association between adverse pregnancy outcomes and the predicted 30-year risk of atherosclerotic cardiovascular disease (CVD), including coronary artery disease and stroke. The study was a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study–Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. The exposures were adverse pregnancy outcomes during the first pregnancy, including gestational diabetes mellitus (GDM), hypertensive disorder of pregnancy, preterm birth, and small- and large-for-gestational-age (SGA, LGA) birth weight. The outcome was the 30-year risk of atherosclerotic CVD predicted with the Framingham Risk Score assessed at 2–7 years after delivery. The study included 4,273 individuals and found that those who experienced GDM, hypertensive disorder of pregnancy, and preterm birth were more likely to have a higher absolute risk and a high predicted risk of atherosclerotic CVD. A greater number of adverse pregnancy outcomes within the first birth was associated with progressively greater risks.

The study was part of the Nulliparous Pregnancy Outcomes Study–Monitoring Mothers-to-Be Heart Health Study and the follow-up nuMoM2b-HHS, which aimed to better define the relationships between adverse pregnancy outcomes and maternal cardiovascular health. Adverse pregnancy outcomes were defined as GDM, hypertensive disorder of pregnancy, preterm birth, and abnormal birth weight (SGA and LGA). The predicted 30-year risk of atherosclerotic CVD was assessed using the Framingham Risk Score and measured continuously and categorically. The study found that the cumulative number of adverse pregnancy outcomes was associated with a higher risk of atherosclerotic CVD. In addition, the study revealed that individuals with a higher BMI, those with chronic hypertension, and those who reported smoking were more likely to experience an adverse pregnancy outcome.

Study Limitations

Despite the significant findings, the study had limitations. It did not assess the association of adverse pregnancy outcome severity with atherosclerotic CVD risk, and the cohort excluded individuals with pregestational diabetes. However, the study's strengths included leveraging well-characterized adverse pregnancy outcomes through medical record abstraction and rigorous adjudication. This resulted in a geographically and racially diverse population, allowing for the assessment of a dose–response relationship between the number of adverse pregnancy outcomes and the degree of atherosclerotic CVD risk.

Conclusion

In conclusion, the study's findings indicated that individuals who experienced adverse pregnancy outcomes in their first birth were more likely to have a higher predicted 30-year risk of atherosclerotic CVD. These findings underscore the importance of continued risk assessment and engagement in preventive care after an adverse pregnancy outcome to reduce atherosclerotic CVD risk and improve maternal health.

Key Points -

- The research aimed to investigate the association between adverse pregnancy outcomes and the predicted 30-year risk of atherosclerotic cardiovascular disease (CVD), including coronary artery disease and stroke. The study included 4,273 individuals and found that those who experienced gestational diabetes mellitus (GDM), hypertensive disorder of pregnancy, and preterm birth were more likely to have a higher absolute risk and a high predicted risk of atherosclerotic CVD. A greater number of adverse pregnancy outcomes within the first birth was associated with progressively greater risks.

- The study was part of the Nulliparous Pregnancy Outcomes Study–Monitoring Mothers-to-Be Heart Health Study and the follow-up nuMoM2b-HHS. Adverse pregnancy outcomes were defined as GDM, hypertensive disorder of pregnancy, preterm birth, and abnormal birth weight (SGA and LGA). The study found that the cumulative number of adverse pregnancy outcomes was associated with a higher risk of atherosclerotic CVD. Individuals with a higher BMI, chronic hypertension, and those who reported smoking were more likely to experience an adverse pregnancy outcome.

Reference –

Venkatesh KK, Khan SS, Yee LM, Wu J, McNeil R, Greenland P, Chung JH, Levine LD, Simhan HN, Catov J, Scifres C, Reddy UM, Pemberton VL, Saade G, Bairey Merz CN, Grobman WA; Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), and nuMoM2b–Heart Health Study (HHS) Investigators. Adverse Pregnancy Outcomes and Predicted 30-Year Risk of Maternal Cardiovascular Disease 2-7 Years After Delivery. Obstet Gynecol. 2024 Jun 1;143(6):775-784. doi: 10.1097/AOG.0000000000005569. Epub 2024 Apr 5. PMID: 38574364; PMCID: PMC11098696