50. Cardiovascular health in early pregnancy and hypertensive disorders of pregnancy

Abstract

Background Women with a hypertensive disorder of pregnancy (HDP) have an increased risk for cardiovascular disease (CVD). It remains unknown whether this results from the HDP itself or suboptimal cardiovascular health (CVH) before the onset of a HDP. Objective To determine the association between early pregnancy CVH and the risk for a HDP. Secondly, whether early pregnancy CVH is associated with CVH and carotid intima-media thickness (CIMT) after pregnancy, irrespective of a HDP. Methods Women (normotensive [n = 7008]/HDP [n = 240]) participated in the Generation R Study. We determined CVH in early pregnancy and nine years after according to the American Heart Association criteria. CVH comprised of seven metrics (blood pressure, BMI, smoking, physical activity, diet, total-cholesterol and glucose concentrations), which were categorized and weighted as poor, intermediate or ideal (zero, one or two points). All seven metrics combined created the CVH score, ranging from 0 to 14 points. CIMT nine years after pregnancy was used as a preclinical CVD marker. Results Women with higher CVH in early pregnancy had a 22% lower risk of developing a HDP than women with lower CVH. Higher blood pressure, BMI and glucose in early pregnancy were the strongest risk factors for developing a HDP. Higher CVH in early pregnancy was associated with higher CVH after pregnancy, especially after a HDP. Also, women with higher CVH in early pregnancy had a smaller CIMT, irrespective of having had a HDP. Discussion Higher CVH in early pregnancy reduces the risk of developing a HDP and CIMT thickening after pregnancy. Also, women with higher CVH in early pregnancy have higher CVH after pregnancy, especially those with a previous HDP. Remarkably, early pregnancy CVH was a better predictor of CIMT thickening than HDP. Early pregnancy CVH could be used to predict the risk of HDP and optimize CVH both in pregnancy and afterwards.