Association of adverse pregnancy outcomes with cardiovascular risk profile in later life lessons learned from a large prospective population-based cohort-study

Abstract Background An increased cardiovascular risk profile in parous women in later life has been related to maternal outcomes of pregnancy such as hypertension, diabetes, excessive weight gain as well as fetal outcomes such as preterm birth or excessive birth weight. Methods Using data from a large, monocenter, prospective, long-term, population-based cohort, we analysed self-reported data on pregnancy, risk factors and health status of 1,970 women. We examined the correlations between gestational hypertension (gHTN), gestational diabetes (gDM) and excessive weight gain during pregnancy with hypertension (HTN), diabetes (DM), hyperlipoproteinemia (HLP) and body-mass-index (BMI) in later life. Regarding adverse fetal outcomes, we investigated correlations between preterm birth and later hysterectomy/ovariectomy of parous women and birth weight of >4,000 g with parous women’s BMI in later life. The Wilcoxon rank sum test and the Pearson's Chi-squared test were carried out to prove associations. Further logistic regression analyses are planned to assess cardiovascular outcomes such as myocardial infarction, stroke, heart failure and atrial fibrillation in these parous women. The p-value of 0.05 was defined as a standard for significance. Results The median age of 1,970 women upon examination was 63 years. The proportion of gestational hypertension was 8.7%. 18% of women gained more than 20 kg and 2.4% had diabetes during pregnancy. 10% delivered newborns with a birth weight of <2,500 g. 14% delivered newborns with a birth weight of >4,000 g. 19% were smokers and had hyperlipoproteinaemia, 59% were hypertensive and 33% had metabolic syndrome. We found positive correlations between gestational hypertension and hypertension in later life as well as between gestational diabetes and diabetes mellitus. Excessive weight gain during pregnancy was found to relate to elevated BMI in later life as well as current smoking status. Excessive weight gain during pregnancy did, however, not relate to HLP. High birth weight of >4,000 g correlated with elevated BMI in later life. Conclusions In a population-based sample, we were able to demonstrate that pregnancy-related manifestations of cardiovascular risk factors are indeed related to an increased risk profile in later life. There is a profound need for better individual risk stratification in women based on pregnancy-related data in order to deliver optimised early preventative strategies and potentially reduce cardiovascular events in later life.