Cardiovascular health in early pregnancy and circulating biomarkers of placental health and function

Abstract

Background Maternal cardiovascular health (CVH) and placental health are related to pregnancy outcomes, yet how early pregnancy CVH affects placentation is not well characterized. The objective of this study was to determine associations between CVH and concentrations of placental proteins. Methods Participants from the nuMoM2b prospective cohort were included (n=2188). Maternal CVH was defined three ways: (1) composite scores using 6 components measured in the 1st trimester (four behavioral components of physical activity, diet, sleep duration, and smoking, and the health factors of blood pressure and body mass index); (2) latent classes of the four behavioral components; and (3) individual health behaviors. Linear regression associated composite CVH, latent classes, and individual health behaviors with 1st and 2nd trimester circulating markers of placental growth and development (pregnancy-associated plasma protein A, PAPP-A), pro-angiogenic (vascular endothelial growth factor, VEGF; placental growth factor, PlGF), and anti-angiogenic factors (soluble FMS-like tyrosine kinase 1, sFlt-1; soluble endoglin, sEng). Results and Conclusions More favorable composite CVH was associated with higher PAPP-A (representing better 1st trimester placental growth and development) and lower VEGF and higher sEng (representing an anti-angiogenic 1st trimester profile). Higher levels of physical activity were associated with lower 2nd trimester PAPP-A and higher 1st trimester VEGF and lower sFlt-1 (pro-angiogenic). In the four groups identified with latent class analysis (Healthy Behaviors, Active with Poor Diet, Inactive with Poor Diet, and Less Healthy Behaviors), first trimester sFlt-1 was lower in the Healthy Behaviors group compared to Inactive with Poor Diet group. Modifiable aspects of CVH in early pregnancy are related to placental health and function and may be useful targets for intervention.