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Published on: January 12, 2018
Blood Pressure Patterns and Subsequent Coronary Artery Calcification in Women Who Delivered Preterm Births
Janet M Catov1, Gabrielle G Snyder2, Abigail Fraser
1From the Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute (J.M.C.) catovjm@upmc.edu.
Insights
Women delivering preterm infants may develop higher blood pressure over time, increasing their risk for coronary artery calcification (CAC) later in life. This study links preterm birth to cardiovascular disease risk factors and midlife CAC.
Area of Science:
- Cardiovascular epidemiology
- Reproductive health
- Vascular biology
Background:
- Preterm delivery is linked to increased cardiovascular disease (CVD) risk in women.
- The specific vascular pathways connecting preterm birth to CVD remain unclear.
- Understanding these pathways is crucial for early CVD risk identification in women with a history of preterm birth.
Purpose of the Study:
- To investigate the association between blood pressure trajectories over 25 years and coronary artery calcification (CAC) in women who delivered preterm.
- To determine if preterm delivery modifies the relationship between blood pressure patterns and midlife CAC.
- To explore the influence of hypertensive disorders of pregnancy on this association.
Main Methods:
- Utilized data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, including 1049 black and white women.
- Employed latent mixture modeling to identify distinct systolic blood pressure (SBP) trajectories over 20 years.
- Related identified SBP patterns to CAC measured at years 20 and 25, analyzing interactions with preterm birth status.
Main Results:
- Identified three SBP patterns: low stable (53%), moderate (40%), and moderate increasing (7%).
- Women with moderate-increasing SBP were more likely to have delivered preterm (40% vs. 21%) and had higher CAC rates (38.5% vs. 12.2%).
- Preterm delivery significantly interacted with SBP patterns, with women experiencing both preterm birth and moderate-increasing SBP showing a 2.17-fold increased hazard of CAC.
Conclusions:
- Women delivering preterm infants are more prone to developing high-risk blood pressure patterns during their childbearing years.
- These elevated blood pressure patterns are significantly associated with coronary artery calcification in midlife.
- The findings highlight the importance of monitoring cardiovascular health in women with a history of preterm delivery, even in the absence of hypertensive disorders of pregnancy.
Abstract:
Women who delivered preterm infants have excess cardiovascular disease, but vascular pathways linking these conditions are not understood. We considered that higher blood pressure over 25 years among women with preterm delivery may be associated with coronary artery calcification (CAC). The CARDIA study (Coronary Artery Risk Development in Young Adults) enrolled 1049 black and white women with births between 1985 and 2010 (n=272 ever preterm [<37 weeks]; n=777 all term births [≥37 weeks]). Latent mixture modeling identified blood pressure trajectories across 20 years, and these were related to CAC at years 20 and 25. Three systolic blood pressure (SBP) patterns were identified: low stable (n=563; 53%), moderate (n=416; 40%), and moderate increasing (n=70; 7%). Women with moderate-increasing SBP were more likely to have delivered preterm compared with those in the low-stable group (40% versus 21%; P<0.0001), and they were more likely to have CAC (38.5% versus 12.2%). The SBP and CAC association varied by preterm birth (P interaction=0.04). Women with preterm delivery and a moderate-increasing SBP had a 2.17-fold higher hazards of CAC (95% confidence interval, 1.14-4.12) compared with women with term births and a lower SBP pattern, adjusted for cardiovascular disease risk factors and other pregnancy features. There was no excess CAC in women with moderate-increasing SBP and term births (adjusted hazard ratio, 1.02; 95% confidence interval, 0.49-2.14). Associations were stronger in women with hypertensive disorders of pregnancy but also detected in those with normotensive preterm deliveries. Women who deliver preterm infants are more likely to follow a high-risk blood pressure pattern throughout the childbearing years that is associated with CAC at midlife.
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