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Am J Perinatol 2024; 41(S 01): e1976-e1981
DOI: 10.1055/a-2096-0443
Original Article

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

Ashley N. Battarbee 
1   Departments of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Lisa Mele
2   George Washington University Biostatistics Center, Washington, District of Columbia
,
Mark B. Landon
3   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Michael W. Varner 
4   Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
Brian M. Casey
5   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Uma M. Reddy
6   Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development
,
Ronald J. Wapner
7   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Dwight J. Rouse
8   Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
John M. Thorp
9   Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Edward K. Chien
10   Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
,
George Saade
11   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Alan M. Peaceman
12   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Sean C. Blackwell
13   Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
,
for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network › Author Affiliations Funding This study was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; HD27915, HD36801, HD34208, HD34116, HD40485, HD40500, HD27869, HD40560, HD40544, HD53097, HD40512, HD40545) and the National Institutes of Health's National Center for Advancing Translational Sciences (NCATS; UL1TR001070, UL1TR000439). A.N.B. was supported by K23HD103875; Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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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.

Keywords

cardiovascular - diabetes - hypertension - preeclampsia - pregnancy

Note

This study was presented at the 41st annual meeting of the Society for Maternal-Fetal Medicine, January 25–30, 2021.


Supplementary Material



Publication History

Received: 17 February 2023

Accepted: 18 May 2023

Accepted Manuscript online:
18 May 2023

Article published online:
29 June 2023

© 2023. Thieme. All rights reserved.

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