Daily Dose: Obesity Before and During Pregnancy Predicts Future CV Health

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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 findings from a study published in the journal Circulation Research that examined the association between body mass index (BMI), adverse pregnancy outcomes (APOs), and postpartum cardiovascular disease (CVD) risk factors.

The study

Researchers assessed the correlation between BMI and APOs in a sample of adults from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be Heart Health) study, enrolled during the first trimester of pregnancy (6 to 13 weeks/6 days gestation). Participants were screened at 8 sites across the US between 2014 and 2017.1 Eligibility criteria included being nulliparous, aged 18 years or older, with a singleton pregnancy, and no history of prepregnancy hypertension or diabetes. Follow-up was conducted at 3.7 years postpartum.

The primary mediators of interest for analysis were hypertensive disorders of pregnancy, including preeclampsia, eclampsia, and gestational hypertension. The primary outcome was the development of CVD risk factors, measured in 3 cardiometabolic domains: hypertension, hyperlipidemia, and diabetes. Additional APO subtypes were categorized as preterm birth, small for gestational age birth, and gestational diabetes.

The final cohort numbered 4216 participants with an average age of 27 years at the early pregnancy first visit. The overall mean gestational age was 11.4 weeks. The investigators reported normal BMI among 53%, overweight among 25%, and obesity among 22% of participants.

Findings

Investigators observed hypertensive disorders of pregnancy in 15% of the cohort (9% preeclampsia or eclampsia, 6% gestational hypertension). The team reported preterm birth in 8%, small for gestational age birth in 11%, and gestational diabetes in 4%.

Compared with participants who had a normal BMI in early pregnancy, the researchers found that those with overweight or obesity had significantly higher risk of hypertensive disorders of pregnancy.

At the mean follow-up of 3.7 (range, 2-7) years, early pregnancy obesity was associated with a higher incidence of postpartum hypertension, hyperlipidemia, and diabetes. The association remained after adjustments were made for baseline CVD risk-factor levels.

When they analyzed APO associated specifically with hypertensive disorders of pregnancy, researchers found participants at 97% greater risk for postpartum hypertension and a 31% greater likelihood of having hyperlipidemia.

Authors' comment

"This study suggests that APOs are a marker of prepregnancy CVD risk that becomes clinically manifest during the stress of pregnancy and does not significantly independently contribute to CVD risk after pregnancy. However, APOs are an important marker of high CVD risk and may serve as an important clinical marker for more intensive preventive interventions to reduce lifetime risk of CVD."

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