Adverse pregnancy outcomes and renal-vascular function in the early years after delivery

Abstract

Background: Adverse pregnancy outcomes (APOs: hypertensive disorders, gestational diabetes, preterm birth, placental disorders) are associated with cardiovascular disease risk or blood volume abnormalities. Traditional risk factors might not identify highest risk people in the early years after APO deliveries. Purpose: Test the hypothesis that vascular function is worse and plasma volume-regulating renal hormones lower after delivery in people who did versus did not have an APO. Methods: Adult participants 6 months-3 years post-delivery of a singleton infant participated in this cross-sectional study. Exclusion criteria included current smoking, current use of certain medications, and diabetes outside of pregnancy. Differences in measurements between participants with versus without APOs were determined with t-tests or Wilcoxon tests. Associations of renal hormones with APO history were assessed with linear regression, adjusted for age, race, BMI, and sodium consumption. Results: Of 86 participants, 38 (44%) had an APO history. Those with APOs were more likely to identify as Black and had a higher BMI: 34.0 kg/m2 (IQR:24.6, 39.3) versus 24.2 kg/m2 (IQR:21.2, 31.3), p<0.05. Most brachial and all aortic blood pressures were higher in those with APOs: median aortic blood pressure was 102/74 versus 96/68 mmHg, p≤0.05. There were no differences in arterial stiffness or endothelial function between groups. Aldosterone was lower (54 (IQR:28-84) versus 80 (IQR:39-150) pmol/L) in participants with past APOs. Conclusions: Blood pressures were higher, and aldosterone was lower, in participants with past APOs. Associations of aldosterone with APO history persisted after adjustment. Neither renin nor aldosterone were related to vascular function.