DOI: 10.1161/circ.148.suppl_1.17032 ISSN: 0009-7322

Abstract 17032: Association of Blood Pressure Patterns During Pregnancy With Incident Hypertension and Cardiovascular Disease Risk at 2-7 Years After Delivery: The nuMoM2b Heart Health Study

Natalie A Cameron, Xiaoning Huang, Lucia C Petito, Rebecca B McNeil, Jasmina Varagic, Janet M Catov, C Noel Bairey Merz MD, FACC, FAHA, FESC, Judith Chung, David Haas, Lisa Levine, George Saade, Robert Silver, Uma Reddy, Brian Mercer, Lynn Yee, Philip Greenland, William Grobman, Sadiya S Khan
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine
Show PDF Cite

Introduction: Hypertensive disorders of pregnancy (HDP) are risk factors for cardiovascular disease (CVD). However, associations between subclinical blood pressure (BP) elevations in pregnancy and CVD risk are unknown.

Aims: To identify BP patterns during pregnancy among individuals without HDP and determine their association with long-term CVD risk and hypertension (HTN) 2-7 years after delivery.

Methods: We included nulliparous individuals from the prospective, multicenter nuMoM2b Study Heart Health Study (nuMoM2b-HHS) who had

>
1 BP from each trimester, and excluded those with chronic HTN or HDP. We modeled patterns using group-based trajectory analysis of the mid-BP (average of systolic and diastolic BP) during pregnancy. We selected the final number of groups based on the Bayesian Information Criteria. At 2-7 years after delivery, 30-year predicted CVD risk was estimated using the Framingham risk score; incident HTN was defined as BP
>
130/80. Generalized linear models estimated associations between mid-BP trajectory group and CVD risk, adjusting for sociodemographics, adverse pregnancy outcomes, and first-trimester mid-BP.

Results: Of 3309 participants, mean age was 27.1 (SD 5.5) years. Five mid-BP groups were identified ( FIGURE ). Incident HTN at mean follow-up of 3.7 years after delivery was 4.2% in low-stable, 11.1% moderate-stable, 21.4% moderate-decreasing, 21.8% moderate increasing, and 44.2% in elevated-stable groups. Compared with the moderate-stable group, adjusted 30-year predicted CVD risk was significantly higher by 0.8% (0.4, 1.1), 1.6% (0.9, 2.3) and 2.6% (2.1, 3.1) in the moderate-decreasing, moderate-increasing and elevated-stable groups, respectively.

Conclusions: Among people not meeting HDP criteria, but with elevated mid-BP during pregnancy, nearly half had HTN within 5 years after delivery, and long-term CVD risk was higher. Mid-BP elevations during pregnancy may inform long-term CVD risk even in the absence of HDP.

More from our Archive