Cardiovascular health in early pregnancy and circulating placental biomarkers

Maternal cardiovascular and placental health are related to pregnancy outcomes, yet how cardiovascular health (CVH) in early pregnancy affects placentation is not well characterized. Our objective was to estimate associations between CVH and concentrations of placental proteins. We hypothesized that more favorable CVH metrics would be associated with more favorable circulating concentrations of pregnancy-associated plasma protein A (PAPP-A), vascular endothelial growth factor (VEGF), placental growth factor (PlGF), soluble FMS-like tyrosine kinase 1 (sFlt-1), and soluble endoglin (sEng) in the 1 ^st and 2 ^nd trimesters.

Participants from the nuMoM2b prospective cohort with valid biomarker measures were included (n=2188). Maternal CVH was defined using the American Heart Association's Life's Essential 8 composite score, averaging six components measured in the 1 ^st trimester: body mass index (BMI), blood pressure, physical activity, diet, sleep duration, and smoking. Individual component scores were also evaluated. Linear regression associated scores with 1 ^st and 2 ^nd trimester circulating placental biomarkers.

Higher (more favorable) composite CVH scores were associated with higher PAPP-A (favorable) in both trimesters. In contrast, higher CVH scores were associated with lower VEGF, higher sFlt-1, and higher sEng in the 1 ^st trimester (adverse). Healthier BMI scores demonstrated similar associations as those found with composite CVH. Greater physical activity was associated with more favorable 1 ^st trimester profiles (higher VEGF and lower sFlt-1), but lower 2 ^nd trimester PAPP-A. Composite CVH, potentially driven by BMI and physical activity components, may be an important factor relating to circulating concentrations of placental biomarkers in the first half of pregnancy.