Good cardiovascular health in early pregnancy was linked to lower risk of hypertension even in women at genetic risk of the condition, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2024, September 5–8.
In a study of over 5,000 pregnant women, they found that, compared to those with unfavorable cardiovascular health, favorable cardiovascular health was associated with a 35–62% lower risk of developing a hypertensive disorder of pregnancy across all genetic risk groups.
Hypertensive disorders of pregnancy, such as gestational hypertension and preeclampsia, are a leading cause of death in both expectant mothers and newborns. Preeclampsia alone is thought to account for up to 12% of all yearly worldwide maternal deaths and be responsible for 25% of fetal and neonatal deaths.
These researchers used a polygenic risk score to predict a pregnant person’s chance of developing these conditions based on their genetic profile. Then, they used the American Heart Association’s Life’s Essential 8 (LE8) scoring system to evaluate how cardiovascular health affects this risk.
“We were looking to see if there was an association between cardiovascular health during early pregnancy and risk of developing a hypertensive disorder of pregnancy such as preeclampsia or gestational hypertension, even across genetic risk groups for these diseases,” said study coauthor Vineetha Mathew, a fourth year MD-candidate at Tufts University School of Medicine in Boston.
“Our results found that across all genetic risk groups, better first trimester cardiovascular health may partially mitigate the risk of adverse pregnancy outcomes and the risk of developing hypertensive disorders of pregnancy.”
For the analysis, researchers classified each individual’s genetic risk using a previously validated polygenic risk score, which estimates susceptibility to a disease based on the aggregate effect of millions of genetic variants across the genome. In addition, a cardiovascular health scoring system categorizing first trimester health status from favorable to unfavorable was adapted from the Association’s Life’s Essential 8 (LE8) and assigned to each woman.
Seven out of eight of the LE8 components (diet, physical activity, sleep, nicotine exposure, diabetes, baseline blood pressure, and body mass index—not cholesterol levels) were incorporated into a cardiovascular health score for the entire cohort of pregnant individuals. Cholesterol was added for a sub-group (47%) for whom these values were measured.
“Genetic risk combined with favorable cardiovascular health was comparable or even better than those with low genetic risk but unfavorable cardiovascular health,” Mathew said.
“Based on our research, we want to underscore the importance of preconception and early pregnancy cardiovascular health counseling. OB-GYN and primary care professionals should emphasize cardiovascular health improvement, healthier nutrition, weight management and healthy blood pressure to patients who are considering pregnancy,” Mathew said.
“Prevention is becoming the forefront of medicine. Start early, even before pregnancy, when you are just considering pregnancy. We want to target cardiovascular health at that stage because it can have an impact on pregnancy outcomes and on later-life cardiovascular disease.”
