Cardiovascular Disease-Related Pregnancy Complications Are Associated with Increased Maternal Levels and Trajectories of Cardiovascular Disease Biomarkers During and After Pregnancy

Abstract

Background: Having a pregnancy complicated by hypertensive disorders of pregnancy (HDP) and/or having a small or preterm baby put a woman at risk for later cardiovascular disease (CVD). It is uncertain if higher maternal CVD risk factors (reflected by increased peripartum CVD biomarker levels) account for this risk, or if experiencing a complicated pregnancy itself increases a woman's CVD risk (reflected by an increase in biomarker trajectories from early pregnancy to postpartum). Methods: We conducted a secondary analysis of an 8-week mindful eating and stress reduction intervention in 110 pregnant women. We used mixed linear regression analysis to compare CVD biomarker levels and trajectories, between women with and without a CVD-related pregnancy complication (including HDP [gestational hypertension or preeclampsia] or having a small for gestational age [<10th percentile] or preterm [<37 weeks] baby), at three times: (1) 12-20 weeks of gestation, (2) 3 months postpartum, and (3) 9 months postpartum. CVD biomarkers studied included serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), body mass index (BMI), blood pressure (BP), interleukin-6 (IL-6), tumor necrosis factor, and lipids. We adjusted for age, maternal smoking, prepregnancy BMI, BP, age × time, and BMI × time. Results: Women had a mean age of 28 years (standard deviation [SD] 6), mean prior pregnancies of 0.8 (SD 1.0), and 22 women had one or more CVD-related pregnancy complications. HOMA-IR, diastolic BP, triglyceride, high-density lipoprotein cholesterol, and IL-6 average levels, but not trajectories, differed among women with complicated versus normal pregnancy (all p values were ≤0.04). Peripartum glucose and systolic BP trajectories were statistically greater in complicated versus normal pregnancies (p values were 0.008 and 0.01, respectively). Conclusion: We conclude that the experience of a complicated pregnancy in addition to elevated CVD risk factor levels may both increase a woman's risk of future CVD. ClinicalTrials.gov Identifier: NCT01307683.

Keywords: adverse pregnancy outcomes; blood pressure; cardiovascular biomarkers; insulin resistance; lipids; trajectory.

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.

(A–D) Glucose, insulin, HOMA-IR, and BMI levels and trajectories in pregnancy and postpartum in normal pregnancy (dashed gray line, n = 88) compared with CVD-related pregnancy complications (black solid line, n = 22). Data points represent adjusted means with standard error bars. Mixed model linear regression was used to test differences in levels and trajectory between two groups. The horizontal axis represents months relative to delivery and −6 refers to 12–20 weeks of gestation. BMI, body mass index; CVD, cardiovascular disease; HOMA-IR, homeostasis model assessment of insulin resistance.

FIG. 2.

(A–D) Systolic blood pressure, diastolic blood pressure, IL-6, and TNF levels and trajectories in pregnancy and postpartum, in normal pregnancy (dashed gray line, n = 88) compared with CVD-related pregnancy complications (black solid line, n = 22). Data points represent adjusted means with standard error bars. Mixed model linear regression was used to test differences in levels and trajectory between two groups. The horizontal axis represents months relative to delivery and −6 refers to 12–20 weeks of gestation. IL-6, interleukin-6; TNF, tumor necrosis factor.

FIG. 3.

(A–D) Lipid levels and trajectories in pregnancy and postpartum, in normal pregnancy (dashed gray line, n = 88) compared with CVD-related pregnancy complications (black solid line, n = 22). Data points represent adjusted means with standard error bars. Mixed model linear regression was used to test differences in levels and trajectory between two groups. The horizontal axis represents months relative to delivery and −6 refers to 12–20 weeks of gestation.