Latency of Hypertensive Disorders of Pregnancy and Cardiovascular Risk 2-7 Years After Delivery

To evaluate the association between latency of expectant management in individuals with preterm onset of a hypertensive disorder of pregnancy (HDP) and markers of cardiovascular risk 2-7 years after a first pregnancy.

This was a secondary analysis of the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be)-Heart Health Study, a prospective study with adjudicated pregnancy outcomes and follow-up cardiovascular measures 2-7 years after the first birth. Participants were included if HDP was diagnosed before 37 weeks of gestation and they did not have pregestational hypertension or diabetes. Latency, the interval between HDP diagnosis and delivery, was categorized as short (2-7 days) or long (more than 7 days) for univariate analyses and treated as continuous for regression analyses. The primary outcome was the American Heart Association's Life's Essential 8 health factor score 2-7 years after delivery using body mass index (BMI), blood pressure, non-high-density lipoprotein (non-HDL) cholesterol, and hemoglobin A 1C . Secondary outcomes included high-sensitivity C-reactive protein (CRP) and N-terminal probrain natriuretic peptide (NT-proBNP) concentrations 2-7 years after delivery. Multivariable linear regression models were adjusted for prespecified covariates, with sensitivity analyses for early-onset (before 34 weeks of gestation) and severe HDP.

Among 142 participants with preterm-onset HDP, 30 had short latency and 112 had long latency (median 17.5 days, interquartile range 9-35 days). In adjusted regression models, longer latency was not associated with the overall Life's Essential 8 health factor score (β=-0.26, 95% CI, -0.94 to 0.41, P =.44) but was associated with lower non-HDL scores (β=-1.36, 95% CI, -2.50 to -0.21, P =.02) and higher high-sensitivity CRP (β=0.05 log[mg/dL], 95% CI, 0.001-0.10, P=.04 ). Other Life's Essential 8 health factor score components and NT-proBNP did not differ between groups. Sensitivity analyses demonstrated that early-onset and severe HDP subtypes did not account for latency-related differences.

In this prospective cohort of individuals with preterm HDP in first pregnancies, longer latency of expectant management was not associated with differences in overall cardiovascular health 2-7 years after pregnancy but was associated with adverse subclinical inflammatory and lipid measures, suggesting elevated subclinical cardiovascular risk.