Abstract 33: Associations of Gestational Cardiovascular Health With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study

Abstract

Introduction: Combinations of risk factor levels typically contribute more to population burdens of disease than single adverse risk factors. CVH (as defined by the AHA) characterizes a range of health levels, but its significance in pregnancy for obstetric and neonatal outcomes is unknown. Methods: Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,754 mother-child dyads from 9 field centers in 6 countries: US (26%), Barbados (24%), UK (20%), China (15%), Thailand (8%), and Canada (7%). Maternal CVH was scored (0-10 points, with 10 most favorable) at a mean of 28 (range 23-34) weeks’ gestation using 5 metrics ( Table ). Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of gestational CVH with obstetric and neonatal outcomes, adjusted for center and maternal and infant characteristics ( Table footnote). Results: The mean gestational CVH score was 8.2 (SD 1.5) out of 10; 18% of mothers had all ideal, 37% had 1+ intermediate, 34% had 1 poor, and 9% had 2+ poor metrics. In fully adjusted models ( Table ), odds ratios per 1 point higher (better) CVH score were 0.65 (95% CI, 0.56-0.76) for preeclampsia, 0.89 (0.78-1.00) for unplanned primary cesarean section (among primiparous mothers), 0.84 (0.77-0.93) for large for gestational age infant, 0.87 (0.79-0.97) for infant sum of skinfolds >90 th percentile, and 0.77 (0.69-0.86) for infant insulin sensitivity index (20/[C-peptide*glucose]) <10 th percentile. CVH categories were also associated with outcomes; for example, compared with mothers with all metrics ideal, odds ratios for preeclampsia were 2.00 (0.71-7.14) for mothers with 1+ intermediate, 4.34 (1.63-15.09) for mothers with 1 poor, and 9.40 (3.22-34.52) for mothers with 2+ poor metrics. Conclusion: More favorable levels of gestational CVH were associated with healthier obstetric and neonatal outcomes in this multinational cohort.