Impact of prior preterm or term small for gestational age birth on maternal blood pressure during the menopause transition in the Study of Women's Health Across the Nation

Abstract

Objective: To examine whether blood pressure (BP) accelerates more rapidly during the menopause transition for women with a history of preterm or term small for gestational age (SGA) delivery compared to women with all term and appropriate for gestational age (AGA) births.

Methods: A longitudinal analysis was conducted with 1,008 parous women who had BP data at ≥2 study visits. We used generalized linear modeling to examine BP before the final menstrual period, at the final mentrual period, and up to 10 years after the final menstrual period, according to pregnancy group. We assessed maternal changes in BP over time in relation to years near the final menstrual period using a piece-wise linear model, consistent with menopause-induced changes. Models were adjusted for socio-demographics, body mass index, smoking, physical activity, medications, parity, age at first birth, gestational diabetes, and gestational hypertension/preeclampsia.

Results: At baseline, women were on average 46 years old, 101 (10%) reported a prior preterm birth, and 102 (10.1%) reported a term SGA birth. Compared to women with all term AGA births, women with a term SGA birth had higher BP before the final menstrual period, at the final menstrual period, and up to 10 years after the final menstrual period; women with a preterm birth had higher BP in the postmenopausal years. Annual rate of change in BP during the menopause transition did not differ between pregnancy groups.

Conclusions: Women with a history preterm and term SGA delivery have higher BP than women with all term AGA births during the menopause transition, but rate of change in BP does not differ in these groups relative to final menstrual period.

Figure 1.

Systolic blood pressure (unadjusted, A; adjusted, B) and diastolic blood pressure (unadjusted, C; adjusted, D) at baseline, at the final menstrual period, and at Visit 13, according to pregnancy group (n=1008) assessed separately using generalized linear models. Adjusted models controlled for age, study site, race/ethnicity, financial strain, ever smoker, physical activity, menopause status, BMI, anti-hypertensives, anti-diabetic medication, lipid-lowering medications, parity, age at first birth, history of gestational hypertension/preeclampsia and gestational diabetes. AGA=appropriate for gestational age, FMP=final menstrual period, SGA=small for gestational age.