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Medical/Surgical/Diseases/Complications

Poster Session 1

(344) Adverse Pregnancy Outcomes and Predicted 30-year Risk of Maternal Cardiovascular Disease 2-7 years After Delivery

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

To determine whether adverse pregnancy outcomes (APOs) are associated with higher 30-year predicted risk of cardiovascular disease (CVD) 2-7 years after delivery.

Study Design: This was a secondary analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study cohort. The primary exposures included APOs modelled individually: abnormal fetal growth (i.e., either SGA (< 10th percentile) or LGA (> 90th percentile)), hypertensive disorder of pregnancy (HDP), gestational diabetes (GDM), and preterm birth (PTB) < 37 weeks; and secondarily, we examined the total number of APOs (0, 1, >2) that were found to be significantly associated with CVD risk. The primary outcome was high predicted 30-year CVD risk defined ≥10%; secondarily, we evaluated CVD risk as a continuous measure. Predicted risk was quantified by the Framingham Risk Score for atherosclerotic CVD (i.e., coronary heart disease and/or stroke).


Results: Among 4,299 individuals, 12.8% had an SGA infant, 7.6% had a LGA infant, 13.4% developed HDP, 4.3% developed GDM, and 8.3% had a PTB. At 2-7 years after delivery (median: 2.7 years), the median predicted 30-year ASCVD risk was 2.2% (IQR: 1.4, 3.4). Individuals who experienced HDP (aRR: 1.88; 95% CI: 1.15, 3.07), GDM (aRR: 1.95; 95% CI: 1.10, 3.47), and PTB (aRR: 2.26; 95% CI: 1.32, 3.88) were more likely to have a high predicted risk for CVD (i.e., ≥10%) 2-7 years postpartum. High CVD risk increased with the number of APOs experienced (1: aRR: 2.32; 95% CI: 1.40, 3.85; >2: aRR: 3.45; 95% CI: 1.76, 6.76). These results were similar when the predicted probability was analyzed as a continuous outcome. Neither having a LGA nor an SGA infant was associated with CVD risk.

Conclusion: Two-to-seven years after a first pregnancy, individuals who had APOs, including HDP, GDM, and PTB, were more likely to have a higher predicted 30-year risk of CVD. High risk status increased with the number of APOs experienced. These results suggest research is needed to examine the value of APO history in CVD risk scores.