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Maternal Obesity Predicts Heart Disease Risk Better Than Pregnancy Complications

Pregnancy complications such as preeclampsia and gestational diabetes have recently been associated with a higher risk of developing heart disease later in life. But a new Northwestern Medicine study has found obesity before or during pregnancy is the actual root cause of future CVD.

Prior to this study, scientists were unsure which factor—obesity or pregnancy complications—played a larger role in CVD risk years after pregnancy. This large, multicenter, and diverse study is the first to disentangle that question, ultimately determining that prepregnancy obesity is the true driver of both poor pregnancy outcomes and future CVD risk. It’s one of the only studies to follow its participants—about half of whom were overweight or had obesity—from the beginning of their first pregnancy through several years postpartum.

“We demonstrate, for the first time, that adverse pregnancy outcomes are primarily indicators—and not the root cause—of future heart health,” says corresponding author Sadiya Khan, MD, the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “This means that pregnancy just reveals the risk for heart disease that’s already there.”

The study used data from the nuMoM2b Heart Health Study to prospectively follow 4,216 first-time pregnant individuals from the early stages of their pregnancy to an average of 3.7 years postpartum. At the early-pregnancy first study visit, the average maternal age was 27 years old, and 53% had a normal BMI, 25% were overweight, and 22% had obesity. Compared with those with a normal BMI in early pregnancy, individuals with an overweight or obese BMI had a higher risk of developing hypertensive disorders of pregnancy.

‘Pregnancy Is a Natural Stress Test for the Heart’
In the study, the scientists wanted to better understand the associations among maternal obesity, hypertensive disorders of pregnancy, other adverse pregnancy outcomes, and cardiovascular health several years after delivery.

“Our hypothesis was that it may be that the pregnancy complications are unmasking these things since, as we know, pregnancy is a natural stress test for the heart,” Khan says. “These findings are important because if prepregnancy obesity is the culprit or cause of risk, we should be targeting this with interventions. “We don’t want to just wait until people have these cardiovascular events; we want to stop them from happening,” Khan says.

Obesity Intervention Before Pregnancy Is Key
A major throughline of Khan’s research is the idea of the “zero trimester,” or prepregnancy health. By improving health during this critical time in an individual’s life, they can improve outcomes not only for their pregnancy and baby but also for their personal long-term health, Khan explains.

However, it can be difficult to target people before becoming pregnant, Khan says. So, early in the pregnancy may be an opportune time to counsel on heart-healthy habits like diet and exercise when people are more likely to be interacting with clinicians during prenatal visits. “We definitely don’t want to recommend weight loss during pregnancy, but do want to recommend counseling and monitoring for appropriate gestational weight gain,” Khan says. “It’s one of the few times in life that you’re seeing the doctor frequently while you’re healthy.” Pregnant individuals can safely limit their weight gain throughout pregnancy by eating healthfully and exercising moderately or even vigorously, studies have shown.

More About the Study
Pregnant individuals in the study were seen at eight clinical centers across the United States, including Northwestern University. Individuals were 18 years or older and didn’t have any history of prepregnancy hypertension or diabetes. Approximately 15% of all participants experienced a complication related to high blood pressure, 11% had a baby with a low birthweight, 8% had a preterm birth, and 4% had gestational diabetes. In the years following pregnancy, those with complications related to high blood pressure were 97% more likely to have high blood pressure, and 31% were more likely to have high cholesterol.

For some complications, the researchers found body weight didn’t factor into risks. For example, people who were overweight or had obesity didn’t have increased risks for having a preterm birth or a baby with a low birthweight. However, among all participants, those experiencing preterm births had increased risks for having high blood pressure, high blood sugar, or high cholesterol after pregnancy. Having a baby born with a low birthweight wasn’t found to increase risks.

Source: Northwestern University