Elevated Blood Pressure in Pregnancy and Long-Term Cardiometabolic Health Outcomes

Abstract

OBJECTIVE: To examine the association between elevated blood pressure (BP) in the early third trimester and cardiometabolic health 10–14 years after delivery. METHODS: This is a secondary analysis from the prospective HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study). Blood pressure in the early third trimester was categorized per American College of Cardiology/American Heart Association thresholds for: normal BP below 120/80 mm Hg (reference), elevated BP 120–129/below 80 mm Hg, stage 1 hypertension 130–139/80–89 mm Hg, and stage 2 hypertension 140/90 mm Hg or higher. Cardiometabolic outcomes assessed 10–14 years after the index pregnancy were type 2 diabetes mellitus and measures of dyslipidemia, including low-density lipoprotein (LDL) cholesterol 130 mg/dL or higher, total cholesterol 200 mg/dL or higher, high-density lipoprotein (HDL) cholesterol 40 mg/dL or lower, and triglycerides 200 mg/dL or higher. Adjusted analysis was performed with the following covariates: study field center, follow-up duration, age, body mass index (BMI), height, family history of hypertension and diabetes, smoking and alcohol use, parity, and oral glucose tolerance test glucose z score. RESULTS: Among 4,692 pregnant individuals at a median gestational age of 27.9 weeks (interquartile range 26.6–28.9 weeks), 8.5% (n=399) had elevated BP, 14.9% (n=701) had stage 1 hypertension, and 6.4% (n=302) had stage 2 hypertension. At a median follow-up of 11.6 years, among individuals with elevated BP, there was a higher frequency of diabetes (elevated BP: adjusted relative risk [aRR] 1.88, 95% CI, 1.06–3.35; stage 1 hypertension: aRR 2.58, 95% CI, 1.62–4.10; stage 2 hypertension: aRR 2.83, 95% CI, 1.65–4.95) compared with those with normal BP. Among individuals with elevated BP, there was a higher frequency of elevated LDL cholesterol (elevated BP: aRR 1.27, 95% CI, 1.03–1.57; stage 1 hypertension: aRR 1.22, 95% CI, 1.02–1.45, and stage 2 hypertension: aRR 1.38, 95% CI, 1.10–1.74), elevated total cholesterol (elevated BP: aRR 1.27, 95% CI, 1.07–1.52; stage 1 hypertension: aRR 1.16, 95% CI, 1.00–1.35; stage 2 hypertension: aRR 1.41 95% CI, 1.16–1.71), and elevated triglycerides (elevated BP: aRR 2.24, 95% CI, 1.42–3.53; stage 1 hypertension: aRR 2.15, 95% CI, 1.46–3.17; stage 2 hypertension: aRR 3.24, 95% CI, 2.05–5.11) but not of low HDL cholesterol. CONCLUSION: The frequency of adverse cardiometabolic outcomes at 10–14 years after delivery was progressively higher among pregnant individuals with BP greater than 120/80 in the early third trimester.