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Prepregnancy Body Weight and Future Heart Health

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 Dr Bharti Kalra, Consultant, Dept. of Obstetrics and Gynecology, Bharti Hospital, Karnal, India; and Dr Sanjay Kalra, DM (AIIMS), Treasurer, International Society of Endocrinology;  Bharti Hospital, Karnal, Haryana      26 April 2025

 

In healthy pregnant women, a prepregnancy BMI in the overweight or obese range nearly doubled the risk of gestational diabetes and hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), which were linked to the emergence of multiple cardiovascular risk factors by midlife. These findings were published in the Journal of the American College of Cardiology.1

 

Researchers from Northwestern University, Chicago and The Ohio State University, Ohio conducted this study to evaluate whether adverse pregnancy outcomes (APOs) mediate the relationship between prepregnancy body mass index (BMI) and development of cardiovascular disease (CVD) risk factors in midlife. The analysis included 4269 pregnant women, mean age 30 years, who were enrolled in the Hyperglycemia and Adverse Pregnancy Outcomes Follow-Up Study (HAPO FUS) at mean gestation age of 28 weeks (ranging from 24 to 32 weeks) and who had no history of prepregnancy hypertension or diabetes. The follow-up duration after delivery was 11.6 years.

 

Results showed that around 10.6% participants had prepregnancy obesity, while 21.7% had overweight and 67.7% had normal prepregnancy BMI. 13.8% had gestational diabetes mellitus (GDM) and 10.7% had new-onset hypertensive disorders of pregnancy (HDP). BMI, as calculated by self-reported prepregnancy weight, was within normal range in 67.7%, overweight in 21.7%.

 

At follow-up conducted at a mean age of 41.7 years, participants with prepregnancy obesity had significantly higher mean arterial pressure (MAP) by 7.0 mm Hg, triglyceride levels by 28.5 mg/dL, and hemoglobin A1c (HbA1c) by 0.3% compared to those with a normal prepregnancy BMI. Mediation analysis revealed that GDM accounted for 24.6% of the association between prepregnancy obesity and HbA1c, while new-onset HDP mediated 12.4% of the association between obesity and MAP.

 

In addition, GDM was associated with greater likelihood of developing hypertension (adjusted odds ratio [aOR] 1.72), type 2 diabetes (aOR 7.01), and diabetes or prediabetes by midlife (aOR 4.30) compared with those who did not have gestational diabetes. Similarly, new-onset HDP was also significantly associated with a higher likelihood of hypertension (aOR 3.05), type 2 diabetes (aOR 1.88), and midlife diabetes or prediabetes (aOR 1.44) than in those with a normotensive pregnancy.

 

These findings highlight the critical role of pre-pregnancy health in determining long-term cardiovascular outcomes. Pregnancy and reproductive history should be integrated into cardiovascular risk assessment, at midlife or even earlier. Promoting a healthy body weight and lifestyle behaviors prior to conception may help prevent pregnancy complications and also reduce the risk of future CVD.

 

Reference

 

1.   Jaclyn D Borrowman, et al. Prepregnancy adiposity, adverse pregnancy outcomes, and cardiovascular disease risk in midlife. J Am Coll Cardiol. 2025 Apr 22;85(15):1536-1546. doi: 10.1016/j.jacc.2025.02.033.

 

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