Patient and Provider Perspectives on Cardiovascular Health Education and Engagement Following Hypertensive Disorders of Pregnancy: A Qualitative Study.

Timing of outpatient postpartum care utilization among women with chronic hypertension and hypertensive disorders of pregnancy

Cardiovascular disease (CVD) is the leading cause of death among women in Puerto Rico (PR). Cardiovascular disease risk factors (CVDRF) during pregnancy, such as obesity, type 2 diabetes (T2D), hypertension, and hypertensive disorders of pregnancy, increase risks for maternal and neonatal health. Limited data exist on CVDRF prevalence among pregnant women in PR. This cross-sectional study analyzed medical records of 264 pregnant women aged 21-35 years with no prior pregnancies from an outpatient clinic in San Juan, PR, during 2018-2019. Key CVDRFs included pre-pregnancy obesity, T2D, gestational diabetes, hypertension, and hypertensive disorders of pregnancy. Age groups (21-25, 26-30, 31-35 years) were assessed for CVDRF prevalence. Logistic and multinomial regressions adjusted for sociodemographic variables were used to evaluate associations. Pre-pregnancy obesity was the most prevalent CVDRF (23.5%). Women aged 31-35 years had significantly higher odds of T2D/ gestational diabetes (OR=4.66; 95% CI=1.18, 18.4) and were more likely to experience two or more CVDRFs (RRR=2.73; 95% CI=1.10, 6.80). Findings align with global data showing increased CVDRF prevalence with age among pregnant women. Comparisons with Latino and non-Latino populations reveal shared risks, such as higher rates of gestational diabetes and obesity in older age groups, emphasizing the universal relevance of addressing maternal CVDRFs. Significance: This study highlights the importance of identifying and managing CVDRF among pregnant women in PR, particularly those aged 31-35 years. The findings provide critical data to inform targeted interventions, optimize prenatal care, and reduce long-term maternal and neonatal complications, contributing to improved health outcomes for Puerto Rican women.

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

Prior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given HDP's vascular underpinnings, it is hypothesized to also be a risk factor for later dementia. We aim to summarize the evidence for the impact of HDP on dementia and consider unique associations between HDP and dementia subtypes. Observational studies on the relationship between HDP and dementia were identified from online electronic databases to July 1, 2021 (PROSPERO identifier: CRD42020185630). We included observational studies published in English. Exposure among women was any HDP and HDP subtypes: gestational hypertension, preeclampsia/eclampsia, or other/unspecified HDP. Outcome was any dementia and dementia subtypes: Alzheimer's disease, vascular dementia, or other/unspecified dementias. For our primary analyses, we included 5 cohort studies with a total of 183 874 women with and 2 309 705 women without HDP. Pooled analysis found a 38% higher risk of all-cause dementia among women with, versus without, any type of HDP (adjusted hazard ratio, 1.38 [95% CI, 1.18-1.61]; P<0.01). When examining association by HDP and dementia subtypes, we found that women with, versus without, any type of HDP had over a 3-fold higher risk of vascular dementia (adjusted hazard ratio, 3.14 [95% CI, 2.32-4.24]; P<0.01). Our findings indicate that maternal history of HDP is an important risk factor for later development of vascular and all-cause dementia. Further research among more racially/ethnically diverse populations quantifying HDP's effect on all-cause dementia, and specifically vascular dementia, is warranted.

118 Cardiovascular disease following hypertensive disorders of pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal/perinatal mortality. In recent work, a genetic risk score improved prediction of HDPs beyond standard clinical risk factors, but the extent to which cardiovascular health (CVH) modifies HDP genetic risk is unknown. Hypothesis: First-trimester CVH can offset genetic risk for HDPs. Methods: We examined genotyped participants of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b). Individual HDP genetic risk was calculated using a validated polygenic score. A composite first-trimester CVH score was adapted from the Life’s Essential 8 model; cholesterol was incorporated in a subset (47%) with available first-trimester values. Genetic risk and CVH were each grouped as low (bottom quintile), intermediate (Q2-4), and high (top quintile). Logistic regression tested the joint association of CVH and genetic risk with HDP, adjusted for age and sociodemographic covariates. Results: Among 5,446 participants (mean age 27.5 years), 1,339 (24.6%) developed HDP (344 [6.3%] preeclampsia, 995 [18.3%] gestational hypertension [GH]). Higher genetic risk and lower CVH were additively associated with risk of HDP ( Figure 1A-B ) with no significant interaction (P[interaction] &gt;0.05). HDP incidence ranged from 11% (low genetic risk, favorable CVH) to 37% (high genetic risk, unfavorable CVH) ( Figure 1C ). Favorable vs. unfavorable CVH was associated with 35-62% lower risk of HDPs across genetic risk groups. Findings were broadly consistent when examining preeclampsia and GH separately and when incorporating cholesterol (i.e., using a complete Life’s Essential 8 score). Among CVH components, nonideal BMI, blood pressure, and diet conferred highest population attributable HDP risk (25%, 14%, and 12%, respectively). Conclusion: Higher genetic risk and lower first trimester CVH were additively associated with risk of developing HDP. Favorable CVH in early pregnancy may partially offset a higher genetic risk for HDP.

Hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia, and eclampsia, contribute to increased maternal morbidity and mortality and long-term cardiovascular disease risk. It is unclear whether HDP arises from pregnancy-specific complications or preexisting maternal cardiovascular traits unmasked during pregnancy. This article evaluates whether cardiovascular health before pregnancy, assessed by the American Heart Association's Life's Essential 8 (LE8) score, is associated with HDP risk. The CARDIA (Coronary Artery Risk Development in Young Adults) is a longitudinal cohort study of 5115 Black and White men and women, aged 18 to 30 years at baseline (1985-1986), and followed for over 30 years (nBlackWomen=1480; nWhiteWomen=1307). The LE8 score (range, 0-100) was calculated using health behaviors (diet, smoking, physical activity, sleep) and clinical metrics (body mass index, blood pressure, cholesterol, glucose). Cardiovascular health was categorized as low (LE8 <50), moderate (LE8 50-79), or high (LE8 ≥80). HDP was self-reported as gestational hypertension, preeclampsia, or eclampsia in pregnancies lasting ≥23 weeks. Generalized mixed models assessed the association between LE8 and HDP among 2036 pregnancies from 1227 women, adjusting for age, time-varying parity, education, income, follow-up time, cumulative births, and multiple gestation. Mean baseline age was 24.1 years, 48.7% were Black women, and 19.9% reported HDP. Women with HDP had lower baseline LE8 scores (77.0 versus 79.5; P<0.01). Compared with high cardiovascular health, moderate (odds ratio, 1.78 [95% CI, 1.13-2.81]) and low cardiovascular health (odds ratio, 3.95 [95% CI, 1.05-14.88]) were associated with increased HDP risk. Lower prepregnancy cardiovascular health is an independent risk factor for HDP. Improving cardiovascular health may reduce HDP risk.

Optimising Women’s Cardiovascular Health After Hypertensive Disorders of Pregnancy: A Translational Approach to Cardiovascular Disease Prevention

Genetic Risk and First-Trimester Cardiovascular Health Predict Hypertensive Disorders of Pregnancy inNulliparous Women.

Recognizing Pregnancy-Associated Cardiovascular Risk Factors

Introduction: Hypertensive Disorders of Pregnancy (HDP) affects ~16% of pregnancies and is associated with a 2- to 4-fold greater risk of cardiovascular disease (CVD). Physical activity (PA) is a known modifiable risk factor for CVD; however, little is known about the CVD risk factors potentially related to postpartum PA after HDP. More research is also needed examining specific behavioral determinants influencing postpartum PA and a postpartum PA intervention would be desired. Purpose: To assess differences in CVD risk factors, behavioral determinants of PA, and desired PA intervention components among postpartum individuals with HDP, stratified by PA level. Hypothesis: Inactive individuals will have more CVD risk factors, different behavioral determinants and desired PA intervention components compared to active individuals after HDP. Methods: Individuals residing in Iowa who were &lt;1 year postpartum and experienced a HDP were recruited to complete online surveys assessing demographics, PA, CVD risk factors, behavioral determinants of PA (e.g., barriers and facilitators of PA), and desired PA intervention components. Individuals were classified as active or inactive using the 2018 PA guidelines for Americans. Results: Participants (N=72) were 30±6 years old, mostly white (84%), and 54% were sufficiently active. Inactive individuals were more likely to be diagnosed with hypertension after delivery, had lower CVD knowledge, and were 2.9 times less likely to identify facilitators of PA compared to active individuals (Table; p&lt;0.05). All indicated interest in a postpartum PA intervention, with inactive individuals expressing greater interest in information on postpartum PA safety, PA while breastfeeding, and social media interventions compared to active individuals (Table; p&lt;0.05). Preferred communication included text, email, and video call. Conclusions: Development of PA interventions after HDP should consider the unique needs of individuals across current postpartum activity levels.

Severe cardiovascular morbidity in women with hypertensive diseases during delivery hospitalization

Background:People whose singleton pregnancy is affected by hypertensive disorders of pregnancy (HDP) are at risk of future cardiovascular disease. It is unclear, however, whether this association can be extrapolated to twin pregnancies. We aimed to compare the association between HDP and future cardiovascular disease after twin and singleton pregnancies.Methods:We conducted a population-based retrospective cohort study that included nulliparous people in Ontario, Canada, 1992–2017. We compared the future risk of cardiovascular disease among pregnant people from the following 4 groups: those who delivered a singleton without HDP (referent) and with HDP, and those who delivered twins either with or without HDP.Results:The populations of the 4 groups were as follows: 1 431 651 pregnant people in the singleton birth without HDP group; 98 631 singleton birth with HDP; 21 046 twin birth without HDP; and 4283 twin birth with HDP. The median duration of follow-up was 13 (interquartile range 7–20) years. The incidence rate of cardiovascular disease was lowest among those with a singleton or twin birth without HDP (0.72 and 0.74 per 1000 person-years, respectively). Compared with people with a singleton birth without HDP, the risk of cardiovascular disease was highest among those with a singleton birth and HDP (1.47 per 1000 person-years; adjusted hazard ratio [HR] 1.81 [95% confidence interval (CI) 1.72–1.90]), followed by people with a twin pregnancy and HDP (1.07 per 1000 person-years; adjusted HR 1.36 [95% CI 1.04–1.77]). The risk of the primary outcome after a twin pregnancy with HDP was lower than that after a singleton pregnancy with HDP (adjusted HR 0.74 [95% CI 0.57–0.97]), when compared directly.Interpretation:In a twin pregnancy, HDP are weaker risk factors for postpartum cardiovascular disease than in a singleton pregnancy.

Background Hypertensive disorders in pregnancy are major causes of maternal and foetal morbidity and have also been associated with long-term maternal risk of cardiovascular diseases. Whilst many retrospective and prospective cohort studies have explored this relationship, it is difficult to make causal inferences from observational studies due to potential residual confounding and bias. Leveraging genetic data predisposing to exposures and outcomes in instrumental variable analysis, Mendelian randomisation (MR) can provide valuable information for causal inference. The aim of this study is to use MR to investigate the relationship between hypertensive disorders in pregnancy and cardiovascular diseases. Methods Uncorrelated single nucleotide polymorphisms (SNPs) were selected as instrumental variables from the FinnGen consortium summary statistics for the exposures of any hypertensive disorder in pregnancy, and its two subgroups of gestational hypertension, and pre-eclampsia or eclampsia. Genetic association estimates for outcomes were extracted from GWAS studies of 122,733 for coronary artery disease, 34,217 cases for ischaemic stroke, 47,309 cases for heart failure and 60,620 cases for atrial fibrillation. All studies included patients predominantly of European ancestry. Primary analysis was conducted using inverse-variance weighted MR. Results Hypertensive disorders in pregnancy were associated with increased risk of coronary artery disease (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.08–1.43; p=0.002); and this association was evident for both gestational hypertension (OR= 1.08; 95% CI: 1.00–1.17; p=0.040) and pre- or eclampsia (OR=1.06; 95% CI: 1.01–1.12; p=0.030). Hypertensive disorders in pregnancy were also associated with increased risk of ischaemic stroke (OR=1.27; 95% CI: 1.12–1.44; p=2.87x10–4). Neither gestational hypertension nor pre-eclampsia were independently associated with increased risk of ischaemic stroke, though effect estimates were consistent in direction. No associations were noted between the three hypertensive disorders in pregnancy and the outcomes of heart failure or atrial fibrillation. Conclusions Our findings provide genetic evidence that supports a likely causal association between hypertension in pregnancy and increased risk of coronary artery disease and stroke. This is consistent with observational evidence and supports the classification of hypertensive disorders in pregnancy as risk factors for cardiovascular disease. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council GEPSI 946647 for EAWSBritish Heart Foundation RG/16/3/32175 for FSN

Microvascular Outcomes in Women With a History of Hypertension in Pregnancy.