0
0
Recent research has linked preeclampsia and gestational diabetes to an elevated risk of developing heart disease later in life. However, a new study from Northwestern Medicine has identified pre-pregnancy or prenatal obesity as the primary underlying cause of future cardiovascular issues.
Previously, it was unclear whether obesity or pregnancy-related complications exerted a greater influence on cardiovascular disease risk in the years following pregnancy. This extensive, diverse study, encompassing numerous centers, has conclusively determined that pre-pregnancy obesity is the fundamental factor contributing to both adverse pregnancy outcomes and future cardiovascular disease risk. Notably, this study uniquely tracked its subjects, nearly half of whom were overweight or obese at the onset of their first pregnancy, for several years postpartum.
Dr. Sadiya Khan, the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician, emphasized, “We demonstrate, for the first time, that adverse pregnancy outcomes are primarily indicators — and not the root cause — of future heart health. This means that pregnancy just reveals the risk for heart disease that is already there.”
The findings of this research will be published on October 10 in the journal Circulation Research. The study relied on data from the nuMoM2b Heart Health Study, which prospectively followed 4,216 first-time pregnant individuals from early pregnancy through an average of 3.7 years postpartum. At the initial study visit during early pregnancy, the average maternal age was 27 years, with 53% having a normal BMI, 25% classified as overweight, and 22% as obese. Compared to those with a normal BMI, individuals with overweight or obese BMI had a higher risk of developing hypertensive disorders of pregnancy.
The study aimed to comprehensively understand the relationships between maternal obesity, hypertensive disorders of pregnancy, other adverse pregnancy outcomes, and cardiovascular health in the years following delivery. Dr. Khan highlighted the significance of addressing pre-pregnancy obesity with interventions, rather than waiting for cardiovascular events to occur.
Dr. Khan’s research underscores the importance of “Zero trimester” health, emphasizing pre-pregnancy health for improved outcomes not only during pregnancy but also for long-term personal health. While targeting individuals before pregnancy can be challenging, early pregnancy presents an opportune time for clinicians to counsel on heart-healthy habits like diet and exercise.
It is worth noting that advocating weight loss during pregnancy is not recommended. Instead, counseling and monitoring for appropriate gestational weight gain are advised. This period offers a unique opportunity for frequent interactions with healthcare providers while individuals are in good health.
Studies have demonstrated that pregnant individuals can safely manage their weight gain through healthy eating and moderate to vigorous exercise. The participants in this study were seen at eight clinical centers across the U.S., including Northwestern University, and were 18 years or older with no history of pre-pregnancy hypertension or diabetes.
Approximately 15% of participants experienced complications related to high blood pressure, 11% had infants with low birth weights, 8% had preterm births, and 4% developed gestational diabetes. In the years following pregnancy, those with high blood pressure-related complications were 97% more likely to have high blood pressure, and 31% were more likely to have high cholesterol. While body weight did not factor into risks for some complications, such as preterm birth or low birth weight, preterm births were associated with increased risks of high blood pressure, high blood sugar, or high cholesterol after pregnancy. Low birth weight did not lead to elevated risks.
