Abstract 17167: Black Women Have Evidence of Cardiometabolic Risk and Damage to the Microvascular Glycocalyx 1 to 10 Years After Uncomplicated Pregnancy

Abstract

Introduction: Endothelial glycocalyx (GCX) is a proteoglycan/glycoprotein rich surface layer that regulates vascular health and function and can be damaged in diabetes and cardiovascular disease. Given the excess risk of adverse pregnancy outcomes (APO), chronic hypertension and CVD in Black compared to White women, we considered that microvasculature and glycocalyx may also differ between groups and contribute to adverse clinical outcomes. Objective: The first step was examining the microvasculature in women with no complications in the index pregnancy (from the medical record) and cardiometabolic risk markers. Methods: Sidestream dark-field imaging of the sublingual microcirculation and glycocalyx was used to compare density, median diameter, perfusion (RBC filling %), and penetration of red cells into the glycocalyx of vessel segments of 20-25μm diameter (PBR), in women 1-10 years after the index pregnancy (mean 8 years after index pregnancy). The study included 67 Black women and 167 White women with no complications (preeclampsia, gestation hypertension, preterm delivery, intrauterine growth restriction or gestational diabetes) in the index pregnancy. Health and pregnancy history were obtained by questionnaire at the study visit. Results: Black women had a greater penetration of red blood cells into the glycocalyx of microvascular segments20-25μm (PBR:2.54±0.41 vs White women 2.40±0.43μm, p=0.02). Perfusion in Black women was reduced (70.5±4.2% vs 72±4.8% p=0.003) compared to white women. Associations remain after adjusting for age, BMI, and time to follow-up. Black women were significantly younger (25± 6 vs 30±5 yrs p<0.001) at index delivery and study visit (34±6 vs 38±6yrs p=0.001); they also had higher BMI both pre-pregnancy (28±7 vs 25±6, p=0.007) and at the study visit (32±7 vs 27±7, p<0.001) and higher fasting insulin(17±36 vs 7±9 p=0.002) at the visit compared to White women. Self-reported history of hypertension, diabetes and APO (outside the index pregnancy) was significantly more common among Black at follow-up. Conclusion: Compared to White women, Black women of reproductive age had evidence of more pronounced microvascular changes potentially related to cardiometabolic risk 1-10 years after an uncomplicated index pregnancy.