The adverse cardiovascular risk factor profile of women with pre-eclampsia develops over time in the years before pregnancy

Abstract

Objective: Women with a history of pre-eclampsia have an elevated lifetime risk of cardiovascular disease that may be partly attributed to an adverse cardiovascular risk factor profile, the etiology of which is unclear. Hypothesising that this adverse risk profile may begin to arise over time in the years before pregnancy, we sought to evaluate the pregravid changes over time in cardiovascular risk factors in women who go on to develop pre-eclampsia and those who do not.

Design: Retrospective cohort study using population-based administrative databases.

Setting: Ontario, Canada.

Population: All nulliparous women who had singleton pregnancies between January 2011 and December 2018.

Methods: All results for the following analytes between January 2008 and the start of pregnancy were identified: A1c, glucose, lipids, and transaminases. Mean values were compared between those with and without preeclampsia. The annual change for each analyte in the years before pregnancy was estimated using generalized estimating equations.

Main outcome measure: Preeclampsia.

Results: The 156 278 women (of whom 3827 developed preeclampsia) had mean 4.0 ± 3.3 pregravid tests overall. The two most recent pregravid tests were performed at median 0.6 and 1.9 years before pregnancy, respectively. Women who developed pre-eclampsia had higher pregravid A1c, fasting glucose, random glucose, LDL-cholesterol, triglycerides, and ALT, and lower HDL-cholesterol, than their peers (all P < 0.0001). In the years before pregnancy, women who went on to develop pre-eclampsia had higher annual increases than their peers in triglycerides (13.8-fold higher; P = 0.0004) and random glucose (1.55-fold higher; P = 0.001), coupled with a greater annual decrease in HDL-cholesterol (9.7-fold higher; P = 0.002). During this time, fasting glucose increased in women who developed pre-eclampsia but decreased in their peers (P = 0.01).

Conclusion: In women who develop pre-eclampsia, an adverse cardiovascular risk factor profile evolves over time in the years before pregnancy.

Tweetable abstract: In women who develop pre-eclampsia, an adverse CV risk factor profile evolves in the years before pregnancy.

Keywords: cardiovascular risk factors; glucose; lipids; pre-eclampsia; preconception; pregravid.