Cardiovascular risk factors before and during pregnancy: Does pregnancy unmask or initiate risk?

Abstract

Objectives: To understand if pregnancy unmasks previously silent cardiovascular (CV) adverse factors, or initiates lasting injury. Methods: Pre-pregnancy and during pregnancy CV risk factors (blood pressure, fasting lipids, and glucose) from 296 women belonging to studies in the International Childhood Cardiovascular Cohort (i3C) Consortium, a group of studies assessing the relationship between child and adolescent CV risk factors and adult outcomes, were used. Correlation coefficients between the pre-and during pregnancy measures were calculated, and the mean difference between the measures was modeled with adjustment for age, body mass index, race, smoking, and study. Results: Measures were strongly correlated at pre-and during-pregnancy visits (p < 0.01), with r of between 0.30 and 0.55. In most cases, the difference between pre-pregnancy and during-pregnancy did not differ significantly from 0 after adjustment for confounders. Stratification by gestational age indicated stronger correlations with measurements obtained during the first and second trimesters than the third. The correlation did not differ by the time elapsed between the pre-pregnancy and pregnancy visits. Conclusions: Pre-and during-pregnancy CV risk factors are moderately well correlated. This may indicate that susceptible women enter pregnancy with higher risk rather than pregnancy inducing new vascular or metabolic effects.

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association

“…Although there are physiological changes to CVH metrics in pregnancy (eg, increase in body mass index, glucose, lipids), data demonstrate that CVD risk factor levels measured before pregnancy were highly correlated with risk factor levels during pregnancy. 27 This suggests that associations between unfavorable CVH in pregnant individuals and in offspring may stem, at least in part, from the prepregnancy period. 61 Of note, studies of maternal body mass index indicate that prepregnancy body mass index is more strongly associated with both APOs and offspring cardiovascular risk factors in adolescence compared with gestational weight gain.…”

“…25,26 Levels of CVH metrics are highly correlated between the prepregnancy period and pregnancy. 15,27…”

Pregnancy-Related Complications and Incidence of Atrial Fibrillation: A Systematic Review

“…Regarding baseline characteristics such as hypertension and diabetes, there was variability in the definition and inclusion of these conditions between studies which led to large variability in the estimated prevalence between studies. It has commonly been assumed that higher cardiovascular risk during or after pregnancy among women with pregnancy-related complications is largely due to shared pre-pregnancy cardiovascular risk factors [ 40 , 41 ]. However, higher cardiovascular risk profiles later in life in part explain the association between pregnancy-related complications and CVD [ 42 , 43 ].…”

Synergistic effects of cardiovascular health and social isolation on adverse pregnancy outcomes

“…Considering the correlation between CVH before and during pregnancy, 44 incorporating LE8 in conception planning may aid in preventing future APOs. LE8 advocates improvements by lifestyle modification or the use of pharmacotherapy, empowering women to proactively enhance their CVH in preparation for pregnancy.…”