Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk

Author:

Khan Sadiya S.1ORCID,Petito Lucia C.1ORCID,Huang Xiaoning1ORCID,Harrington Katharine1ORCID,McNeil Rebecca B.2ORCID,Bello Natalie A.3ORCID,Bairey Merz C. Noel3ORCID,Miller Eliza C.4ORCID,Ravi Rupa4ORCID,Scifres Christina5,Catov Janet M.6ORCID,Pemberton Victoria L.7ORCID,Varagic Jasmina7,Zee Phyllis C.1,Yee Lynn M.1ORCID,Ray Mitali6,Kim Jin Kyung8ORCID,Lane-Cordova Abbi D.9ORCID,Lewey Jennifer10ORCID,Theilen Lauren H.11ORCID,Saade George R.12ORCID,Greenland Philip1ORCID,Grobman William A.13,

Affiliation:

1. Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K., L.C.P., X.H., K.H., P.C.Z., L.M.Y., P.G.).

2. Research Triangle International, Research Triangle Park, NC (R.B.M.).

3. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (N.A.B., C.N.B.M.).

4. Columbia University Irving Medical Center, New York City, NY (E.C.M., R.R.).

5. Indiana University School of Medicine, Bloomington, IN (C.S.).

6. University of Pittsburgh School of Medicine, Pittsburgh, PA (J.M.C., M.R.).

7. National Heart, Lung, and Blood Institute, Bethesda, MD (V.L.P., J.V.).

8. University of California Irvine School of Medicine, Irvine, CA (J.K.K.).

9. School of Public Health, University of South Carolina, Columbia, SC (A.D.L.-C.).

10. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.L.).

11. University of Utah School of Medicine, Salt Lake City, UT (L.H.T.).

12. University of Texas Medical Branch, Galveston, TX (G.R.S.).

13. The Ohio State University College of Medicine, Columbus, OH (W.A.G.).

Abstract

BACKGROUND: Obesity is a well-established risk factor for both adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD). However, it is not known whether APOs are mediators or markers of the obesity-CVD relationship. This study examined the association between body mass index, APOs, and postpartum CVD risk factors. METHODS: The sample included adults from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be) Heart Health Study who were enrolled in their first trimester (6 weeks–13 weeks 6 days gestation) from 8 United States sites. Participants had a follow-up visit at 3.7 years postpartum. APOs, which included hypertensive disorders of pregnancy, preterm birth, small-for-gestational-age birth, and gestational diabetes, were centrally adjudicated. Mediation analyses estimated the association between early pregnancy body mass index and postpartum CVD risk factors (hypertension, hyperlipidemia, and diabetes) and the proportion mediated by each APO adjusted for demographics and baseline health behaviors, psychosocial stressors, and CVD risk factor levels. RESULTS: Among 4216 participants enrolled, mean±SD maternal age was 27±6 years. Early pregnancy prevalence of overweight was 25%, and obesity was 22%. Hypertensive disorders of pregnancy occurred in 15%, preterm birth in 8%, small-for-gestational-age birth in 11%, and gestational diabetes in 4%. Early pregnancy obesity, compared with normal body mass index, was associated with significantly higher incidence of postpartum hypertension (adjusted odds ratio, 1.14 [95% CI, 1.10–1.18]), hyperlipidemia (1.11 [95% CI, 1.08–1.14]), and diabetes (1.03 [95% CI, 1.01–1.04]) even after adjustment for baseline CVD risk factor levels. APOs were associated with higher incidence of postpartum hypertension (1.97 [95% CI, 1.61–2.40]) and hyperlipidemia (1.31 [95% CI, 1.03–1.67]). Hypertensive disorders of pregnancy mediated a small proportion of the association between obesity and incident hypertension (13% [11%–15%]) and did not mediate associations with incident hyperlipidemia or diabetes. There was no significant mediation by preterm birth or small-for-gestational-age birth. CONCLUSIONS: There was heterogeneity across APO subtypes in their association with postpartum CVD risk factors and mediation of the association between early pregnancy obesity and postpartum CVD risk factors. However, only a small or nonsignificant proportion of the association between obesity and CVD risk factors was mediated by any of the APOs, suggesting APOs are a marker of prepregnancy CVD risk and not a predominant cause of postpartum CVD risk.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine,Physiology

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