Study gives more insight into cardiovascular health in early pregnancy

The preliminary findings were presented at the American Heart Association's Hypertension Scientific Sessions 2024.

Leading scientific interchange on new developments in basic and clinical research on hypertension and its connections to heart and kidney disease, stroke, obesity, and genetics will take place during the Chicago meeting, which takes place from September 5-8, 2024.

Preeclampsia and gestational hypertension are examples of hypertensive disorders of pregnancy that are a major cause of death for both expecting mothers and their unborn children. Based on a person's genetic background, a validated risk model known as a polygenic risk score can be used to estimate the likelihood that they will develop certain disorders. The American Heart Association's Life's Essential 8 (LE8) scoring system is used to determine cardiovascular health in early pregnancy, but it is unclear how much this score influences the risk.

"We were looking to see if there was an association between cardiovascular health during early pregnancy and risk of developing a hypertensive disorder of pregnancy such as preeclampsia or gestational hypertension, even across genetic risk groups for these diseases," said study coauthor Vineetha Mathew, a fourth year M.D.-candidate at Tufts University School of Medicine in Boston. "Our results found that across all genetic risk groups, better first trimester cardiovascular health may partially mitigate the risk of adverse pregnancy outcomes and the risk of developing hypertensive disorders of pregnancy."

The study investigated whether cardiovascular health in the first trimester of pregnancy can offset a genetic risk for developing gestational hypertension and preeclampsia during pregnancy. The researchers analyzed data on more than 5,000 individuals who were pregnant for the first time to calculate the rates of these hypertensive disorders during pregnancy.

For the analysis, researchers classified each individual's genetic risk using a previously validated polygenic risk score, which estimates susceptibility to a disease based on the aggregate effect of millions of genetic variants across the genome. In addition, a cardiovascular health scoring system categorizing first trimester health status from favorable to unfavorable was adapted from the Association's Life's Essential 8 and assigned to each woman. Seven out of eight of the LE8 components (diet, physical activity, sleep, nicotine exposure, diabetes, baseline blood pressure, and body mass index - not cholesterol levels) were incorporated into a cardiovascular health score for the entire cohort of pregnant individuals. Cholesterol was added for a sub-group (47%) for whom these values were measured.

The analysis examined the association of cardiovascular health and genetic risk with preeclampsia and gestational hypertension and was adjusted for age, self-reported race and ethnicity, education level and marital status.

"What was really interesting about our findings was how cardiovascular health in the first trimester appeared to be protective for all. We saw that the odds of developing a hypertensive disorder of pregnancy among those with a high genetic risk combined with favorable cardiovascular health was comparable or even better than those with low genetic risk but unfavorable cardiovascular health," Mathew said.

"Based on our research, we want to underscore the importance of preconception and early pregnancy cardiovascular health counseling. OB-GYN and primary care professionals should emphasize cardiovascular health improvement, healthier nutrition, weight management and healthy blood pressure to patients who are considering pregnancy," Mathew said. "Prevention is becoming the forefront of medicine. Start early, even before pregnancy, when you are just considering pregnancy. We want to target cardiovascular health at that stage because it can have an impact on pregnancy outcomes and on later-life cardiovascular disease."

The study's limitations included cholesterol metrics for about half the participants are missing from the main analysis. Future work for the researchers will involve expanding the study to include a more diverse population and to incorporate cardiovascular health metrics throughout pregnancy as well as risk patterns in subsequent pregnancies.

"These results highlight the importance of the cardiovascular health construct, as measured by the American Heart Association's Life's Essential 8 score, across the entire life course including during pregnancy. The impressive reductions in risk for hypertensive disorders of pregnancy associated with higher cardiovascular health demonstrate that there is much within our control to help patients avoid these potentially lethal pregnancy complications," said Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, chair of the writing group the Association's Presidential Advisory unveiling Life's Essential 8 and a past volunteer president of the American Heart Association. Lloyd-Jones is also the chair of the department of preventive medicine, the Eileen M. Foell Professor of Heart Research and professor of preventive medicine, medicine and pediatrics at Northwestern University's Feinberg School of Medicine in Chicago. "It is particularly notable that high cardiovascular health scores, achievable through a focus on healthy lifestyle, may help mitigate the risk conferred by a person's genes." (ANI)