Better CV Health in Early Pregnancy Offsets High Genetic Risk: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on preliminary research presented at the American Heart Association's (AHA) Hypertension Scientific Sessions 2024, held September 5-8, in Chicago, Illinois.

The study

Researchers aimed to determine if there was an association between cardiovascular health (CVH) during early pregnancy and risk of developing a hypertensive disorder of pregnancy (HDP), such as preeclampsia or gestational hypertension, even across genetic risk groups for those diseases. They examined genotyped participants of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b), conducted between 2010 and 2013. Individual HDP genetic risk was calculated using a validated polygenic score and a composite first-trimester CVH scoring system was adapted from the AHA’s Life's Essential 8 (LE8) model.

Seven out of the 8 components of the LE8 (diet, physical activity, sleep, nicotine exposure, diabetes, baseline blood pressure, and body mass index [BMI]) were incorporated into the CVH score. Cholesterol levels were not available for all participants, so researchers conducted a secondary analysis of a subset of women with available cholesterol measures in the first-trimester. Using these scores, each woman’s CVH was classified as favorable or unfavorable. Researchers adjusted their analysis of the association between CVH and genetic risk and HDP for age, self-reported race and ethnicity, education level, and marital status.

The findings

Among the 5446 participants (mean age, 27.5 years) included in the study, 1339 (24.6%) developed HDP, including preeclampsia (n=344) and gestational hypertension (n=995).

Results showed that a higher genetic risk and lower CVH were additively associated with risk of HDP with no significant interaction (P for interaction > .05). Compared to women with unfavorable CVH (ie, those with the lowest LE8 score), participants with favorable CVH had a 35% to 62% lower risk of developing HDP across all genetic risk groups. The incidence of HDP ranged from 11% among participants with low genetic risk and favorable CVH to 37% among those with a high genetic risk and unfavorable CVH. In addition, among the CVH components, nonideal BMI, blood pressure, and diet contributed most to HDP risk (25%, 14%, and 12%, respectively).

Authors' comment

“Based on our research, we want to underscore the importance of preconception and early pregnancy cardiovascular health counseling. OB-GYN and primary care professionals should emphasize cardiovascular health improvement, healthier nutrition, weight management and healthy blood pressure to patients who are considering pregnancy."

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