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. 2024 May;41(S 01):e1976-e1981.
doi: 10.1055/a-2096-0443. Epub 2023 May 18.

Hypertensive Disorders of Pregnancy and Long-Term Maternal Cardiovascular and Metabolic Biomarkers

Ashley N Battarbee  1 , Lisa Mele  2 , Mark B Landon  3 , Michael W Varner  4 , Brian M Casey  5 , Uma M Reddy  6 , Ronald J Wapner  7 , Dwight J Rouse  8 , John M Thorp  9 , Edward K Chien  10 , George Saade  11 , Alan M Peaceman  12 , Sean C Blackwell  13 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Affiliations

Hypertensive Disorders of Pregnancy and Long-Term Maternal Cardiovascular and Metabolic Biomarkers

Ashley N Battarbee et al. Am J Perinatol. 2024 May.

Abstract

Objective: This study aimed to measure the association between hypertensive disorders of pregnancy (HDP) and long-term maternal metabolic and cardiovascular biomarkers.

Study design: Follow-up study of patients who completed glucose tolerance testing 5 to 10 years after enrollment in a mild gestational diabetes mellitus (GDM) treatment trial or concurrent non-GDM cohort. Maternal serum insulin concentrations and cardiovascular markers VCAM-1, VEGF, CD40L, GDF-15, and ST-2 were measured, and insulinogenic index (IGI, pancreatic β-cell function) and 1/ homeostatic model assessment (insulin resistance) were calculated. Biomarkers were compared by presence of HDP (gestational hypertension or preeclampsia) during pregnancy. Multivariable linear regression estimated the association of HDP with biomarkers, adjusting for GDM, baseline body mass index (BMI), and years since pregnancy.

Results: Of 642 patients, 66 (10%) had HDP: 42 with gestational hypertension and 24 with preeclampsia. Patients with HDP had higher baseline and follow-up BMI, higher baseline blood pressure, and more chronic hypertension at follow-up. HDP was not associated with metabolic or cardiovascular biomarkers at follow-up. However, when HDP type was evaluated, patients with preeclampsia had lower GDF-15 levels (oxidative stress/cardiac ischemia), compared with patients without HDP (adjusted mean difference: -0.24, 95% confidence interval: -0.44, -0.03). There were no differences between gestational hypertension and no HDP.

Conclusion: In this cohort, metabolic and cardiovascular biomarkers 5 to 10 years after pregnancies did not differ by HDP. Patients with preeclampsia may have less oxidative stress/cardiac ischemia postpartum; however, this may have been observed due to chance alone given multiple comparisons. Longitudinal studies are needed to define the impact of HDP during pregnancy and interventions postpartum.

Key points: · Hypertensive disorders of pregnancy were not associated with metabolic dysfunction.. · Cardiovascular dysfunction was not consistently seen after pregnancy hypertension.. · Longitudinal studies with postpartum interventions after preeclampsia are needed..

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Flow diagram of study cohort
Figure 2.
Figure 2.
Adjusted mean difference of metabolic and cardiovascular biomarkers by presence of a hypertensive disorder of pregnancy Referent = No hypertensive disorder of pregnancy Adjusted for GDM status (treated GDM, untreated GDM, non-GDM), baseline BMI, and years since index pregnancy
Figure 3.
Figure 3.
Adjusted mean difference of metabolic and cardiovascular biomarkers by type of hypertensive disorder of pregnancy present Referent = No hypertensive disorder of pregnancy Adjusted for GDM status (treated GDM, untreated GDM, non-GDM), baseline BMI, and years since index pregnancy
See this image and copyright information in PMC

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