Heart Health during adolescence May Influence Future Pregnancy Outcomes: JAMA
A cohort study suggests that a woman’s cardiovascular health during adolescence and young adulthood may influence certain pregnancy outcomes later in life Further women maintaining optimal cardiovascular health from adolescence through young adulthood showed the lowest rates of gestational diabetes (GD), hypertension, and hypertensive disorders of pregnancy (HDP), suggesting heart health trajectories may still play a role in maternal outcomes. The study was published in JAMA Network Open by Katharine J. and colleagues.
The worldwide cardiovascular morbidity burden during pregnancy is increasingly climbing. Both GD and HDP not only result in immediate threats during pregnancy but also elevate the mother's long-term risk of cardiovascular morbidity and metabolic disease. This study, based on information from a large, nationally representative cohort, aimed to explain how cardiovascular health in adolescence and young adulthood predicts later-life pregnancy outcomes.
This cohort study examined data from the National Longitudinal Study of Adolescent and Adult Health, from female participants who were interviewed at three stages of life:
1994–1996 (ages 11–19 years) – adolescence
2001–2002 (ages 18–26 years) – young adulthood
2016–2018 (ages 34–43 years) – adulthood
A total of 1,094 female participants were included in the analysis. Participants with juvenile-onset diabetes or hypertension were excluded to eliminate confounding risk factors. The median (IQR) age at baseline was 16 (14–17) years, and the median body mass index (BMI) was 21.6 (19.6–24.5). Cardiovascular health was measured on an adapted Life's Essential 8 scale that ranges from 0 to 100, with increased scores indicating improved cardiovascular health. Participants were divided into three groups:
Optimal CVH
Intermediate CVH
Poor CVH
The analysis studied the relationship between these CVH groups during adolescence and young adulthood with the subsequent development of gestational diabetes (GD) and hypertensive disorders of pregnancy (HDP).
Key Findings
The results showed a strong correlation between adverse cardiovascular health in youth and subsequent risk of later pregnancy complications.
Those with adverse adolescent CVH had an adjusted risk ratio (ARR) of 2.01 (95% CI, 0.96–4.24) for gestational diabetes, relative to those with the best CVH.
Those with intermediate adolescent CVH had reduced risk, with an ARR of 1.04 (95% CI, 0.53–2.07) for future GD.
The prevalence of gestational diabetes was 28.5% in those with poor CVH at adolescence and young adulthood, 9.6% in those with intermediate CVH, and 4.7% in those with optimal CVH.
Even in those who progressed to better CVH over time, risk was still significant. Those with poor adolescent CVH but with subsequent optimal young-adult CVH had a 24.9% prevalence of GD, and those with intermediate young-adult CVH had a 14.7% prevalence.
For hypertensive disorders of pregnancy (HDP), suboptimal adolescent CVH had a crude ARR of 1.22 (95% CI, 0.74–2.01) and intermediate adolescent CVH an ARR of 1.43 (95% CI, 0.93–2.21), relative to optimal CVH.
This research proves that poor cardiovascular health during adolescence and early adulthood is linked to a greater risk of gestational diabetes in the future. Optimal cardiovascular health from a young age and sustaining it could thus be an efficient measure to reduce the risk of pregnancy complications like gestational diabetes and hypertensive disorders.
Reference:
McCarthy KJ, Ng A, Boychuk NA, Janevic T. Adolescent Cardiovascular Risk Trajectories and Later-Life Maternal Morbidity. JAMA Netw Open. 2025;8(10):e2536095. doi:10.1001/jamanetworkopen.2025.36095
