Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum

Walter, Jessica; Perng, Wei; Kleinman, Ken; Rifas‐Shiman, Sheryl L.; Rich‐Edwards, Janet W.; Oken, Emily

doi:10.1016/j.ajog.2014.11.012

Cited by 128 publications

(76 citation statements)

References 26 publications

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“…Also, this present analysis may have been underpowered to detect this association.Increases in SBP, DBP and MAP at 34 weeks' gestation increased the risk of HTN stages 1 and 2 at 5 years later. This finding also suggests that although the ROLO study had positive effects of GWG, this did not have a lasting impact on BP, as suggested in previous research 26. MAP is suggested as an indicator of future cardiovascular disease risk in nonpregnant populations 25.…”

supporting

confidence: 69%

Blood pressure in pregnancy—A stress test for hypertension? Five‐year, prospective, follow‐up of the ROLO study

Brady

O’Brien

Geraghty

et al. 2019

Clinical Endocrinology

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Pregnancy is often considered a stress test for life as it may uncover conditions which reappear in later life. Many examples exist such as preeclampsia and the development of hypertension (HTN) postpartum 1 as well as antenatal insulin resistance and the development of type 2 diabetes mellitus postpartum. 2,3 Much research exists on the relationship between maternal blood glucose levels below that diagnostic for gestational diabetes mellitus (GDM) and adverse pregnancy outcomes. In 2018, O'Brien et al demonstrated that each 1 mmol/L increase in fasting blood glucose in early pregnancy leads to a 1.70 mmol/mol increase in HbA1c at 5 years postpartum. 4 Given this relationship, and the metabolic dysregulation which occurs in pregnancy, it is surprising that there is Abstract Objective: To investigate whether maternal blood pressure (BP) below the diagnostic criteria of hypertensive disorders of pregnancy (HDP) is associated with maternal BP 5 years later. Design: Prospective, observational study. Setting: Dublin, Ireland (2007-2011). Sample: Three hundred twenty-nine women from the ROLO study (Randomized cOntrol trial of LOw glycaemic index diet to prevent the recurrence of macrosomia). Methods: Maternal BP measurements were taken during pregnancy (13, 28 and 34 weeks' gestation and day 1 postpartum) and at the 5-year follow-up. Systolic BP (SBP) and diastolic BP (DBP) were categorized as normal (SBP < 120 and DBP < 80 mm Hg), elevated (SBP 120-129 and DBP < 80 mm Hg), HTN stage 1 (SBP 130-139 or DBP 80-89 mm Hg) or HTN stage 2 (SBP ≥ 140 or DBP ≥ 90 mm Hg) at each timepoint. Main Outcome Measures: Maternal blood pressure at the 5-year follow-up.Results: Women with elevated BP at 28 and 34 weeks' gestation had 2.68 (95% CI:1.36-5.26) and 2.45-fold (95% CI: 1.22-4.95) increased odds of HTN stage 1 respectively, at the 5-year follow-up, compared to those with normal BP in pregnancy. Conclusion:Elevated BP at 28 and 34 weeks' gestation was associated with an increased risk of HTN stage 1 at 5 years later. Thus, raised BP, below the diagnostic criteria of HDP, could be flagged for follow-up postpartum. K E Y W O R D Scardiovascular disease, hypertension, maternal hypertension, metabolic syndrome, pregnancy

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supporting

confidence: 69%

Blood pressure in pregnancy—A stress test for hypertension? Five‐year, prospective, follow‐up of the ROLO study

Brady

O’Brien

Geraghty

et al. 2019

Clinical Endocrinology

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“…In conclusion, we identified a significant association between moderately elevated BP in pregnancy and later HTN. This approach parallels that of the increasing recognition that pregnancy factors such as gestational weight gain have immediate consequences for perinatal outcomes as well as long‐term impacts on maternal metabolic and cardiovascular health . In future work, we will focus on further improving the prediction of later life HTN by considering gestational BP measurements alongside other biomarkers measured in pregnancy.…”

Section: Resultsmentioning

confidence: 97%

Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: the POUCHmoms longitudinal study

Dunietz

Strutz

Holzman

et al. 2017

BJOG

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Objective Hypertensive disorders in pregnancy signal an increased risk of cardiovascular disease for women. However, future hypertension risk among pregnant women with moderately elevated blood pressure (BP) is unknown. We examined associations among moderately elevated BP or hypertensive disorders during pregnancy and later prehypertension or hypertension. Design Longitudinal cohort study. Setting Five communities in Michigan, USA. Sample Data are from pregnant women enrolled in the Pregnancy Outcomes and Community Health Study. We included 667 women with gestational BP measurements who participated in the POUCHmoms Study follow-up 7-15 years later. Methods Moderately elevated BP was defined as two measures of systolic BP ≥120 mmHg or diastolic BP ≥80 mmHg among women without a hypertensive disorder. Weighted multinomial logistic regression models estimated odds of prehypertension or hypertension at follow-up, adjusted for maternal confounders and time to follow-up. Main Outcome Measures Prehypertension or hypertension. Results Women meeting the moderately elevated BP criteria (64%) had significantly higher odds of hypertension at follow-up (adjusted odds ratio =2.6; 95% confidence interval: 1.2-5.5). These increased odds were observed for moderately elevated BP first identified before or after 20 weeks, and for elevated systolic BP alone or combined with elevated diastolic BP. Conclusions Moderately elevated BP in pregnancy may be a risk factor for future hypertension. Pregnancy offers an opportunity to identify women at risk for hypertension who may not have been identified otherwise.

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“…As previously reported, 6,16,17 we performed linear interpolation between the 2 closest weight measures to estimate weights at day 91 and day 182 and calculated GWG rates (kg/wk) for each trimester. We also categorized total gestational weight gain as inadequate, adequate, or excessive according to the 2009 Institute of Medicine (IOM) guidelines, which advise less weight gain for women with higher pre-pregnancy BMI.…”

Section: Methodsmentioning

confidence: 99%

First and second trimester gestational weight gains are most strongly associated with cord blood levels of hormones at delivery important for glycemic control and somatic growth

et al. 2017

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Background Excessive gestational weight gain (GWG) during pregnancy is associated with adverse outcomes for mothers and offspring. Early, mid, and late pregnancy GWG have different associations with fetal growth and later life adiposity, but associations with cord blood hormones, which might predict later health, are not well studied. Methods In 978 pregnant women from the pre-birth Project Viva cohort, we calculated trimester-specific GWG using clinically recorded prenatal weights. Outcomes were levels of umbilical cord blood hormones related to fetal and postnatal growth. We used linear regression models adjusted for maternal race/ethnicity, pre-pregnancy BMI, parity, education, pregnancy smoking status and child sex; 2nd and 3rd trimester models were additionally adjusted for GWG in prior trimesters. Results Mean ± SD pre-pregnancy BMI was 24.9 ± 5.5 kg/m2, 30% were non-white, and 63% were college graduates. Mean ± SD cord blood hormone levels were insulin-like growth factor [IGF]-1 (56.4 ± 24.3 ng/mL), IGF-2 (408.5 ± 92.7 ng/mL), IGFBP-3 (1084 ± 318 ng/mL), insulin (6.5 ± 7.2 uU/mL), C-peptide (1.0 ± 0.6 ng/mL), leptin (9.0 ± 6.6 ng/mL) and adiponectin (28.7 ± 6.8 μg/mL). Mean ± SD 1st, 2nd and 3rd trimester GWG rates were 0.22 ± 0.22, 0.49 ± 0.19 and 0.46 ± 0.22 kg/wk. Greater 1st trimester GWG (per 0.2 kg/wk) was associated with higher insulin (0.5 uU/mL; 95% CI 0.1, 0.9) and c-peptide (0.06 ng/mL; 95% CI 0.02, 0.09) and lower adiponectin (−0.4 μg/mL; 95% CI −0.9, 0.0). Greater 2nd trimester GWG (per 0.2 kg/wk) was associated with higher IGF-1 (2.3 ng/mL; 95% CI 0.6, 4.0), IGF-2 (7.9 ng/mL; 95% CI 1.2, 14.6), IGFBP-3 (41.6 ng/mL; 95% CI 19.4, 63.7) and leptin (0.9 ng/mL; 0.4, 1.4). 3rd trimester GWG was not associated with cord blood hormones. Conclusion 1st trimester weight gain appears to matter more for cord blood hormones related to offspring glucose/insulin regulation, whereas 2nd trimester gain matters more for hormones related to growth and adiposity.

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Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum

Cited by 128 publications

References 26 publications

Blood pressure in pregnancy—A stress test for hypertension? Five‐year, prospective, follow‐up of the ROLO study

Blood pressure in pregnancy—A stress test for hypertension? Five‐year, prospective, follow‐up of the ROLO study

Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: the POUCHmoms longitudinal study

First and second trimester gestational weight gains are most strongly associated with cord blood levels of hormones at delivery important for glycemic control and somatic growth

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