633 Association of second-trimester uterine artery doppler abnormalities with maternal hypertension 2-7 years after delivery

Abstract

Adverse pregnancy outcomes (APO) are associated with future maternal cardiovascular disease. Uterine artery Doppler (UAD) has been used to try to predict APO, and could indicate a greater chance of future maternal cardiovascular risk. We investigated associations between 2nd-trimester UAD parameters with development of new maternal hypertension (HTN) 2-7 years after delivery. The Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be Heart Health Study (nuMoM2b-HHS) is a long-running, prospective cohort study that has followed a diverse cohort of 4475 US women since early in their 1st pregnancies. We calculated odds ratios and 95% confidence intervals for associations between abnormal UAD parameters and incident HTN. Women who had baseline chronic HTN, who did not undergo UAD in the index pregnancy, or who were missing data regarding HTN at follow up were excluded. We defined abnormal UAD as any of the following: presence of early diastolic notch, elevated resistance index (RI), or elevated pulsatility index (PI). We defined HTN as systolic blood pressure ≥130 mmHg, diastolic blood pressure ≥80 mmHg, or self-reported use of an anti-HTN medication at the nuMoM2b-HHS study visit. Models were adjusted for age, BMI, self-reported race/ethnicity, insurance status, smoking, and APO. We tested for interactions between abnormal UAD and APO. A total of 3737 women were included in the analysis, of whom 187 (5%) developed HTN after the index pregnancy (Table 1). The abnormal UAD composite exposure was not associated with incident HTN. However, higher maximum RI and PI were each significantly associated with higher odds of incident HTN (Table 2). APO during the index pregnancy did not significantly modify this association. In this prospective cohort of women followed from early pregnancy, having either a higher RI or PI in the early 2nd trimester was associated with higher odds of developing HTN years after delivery. These UAD abnormalities may be early biomarkers of underlying maternal vascular dysfunction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)