Maintaining favorable cardiovascular health (CVH) in early pregnancy may partially offset the genetic risk for developing hypertensive disorders of pregnancy (HDP), according to new preliminary research.¹

Findings from the study of over 5000 first-time mothers in their first trimester of pregnancy showed that higher CVH scores, as measured by the American Heart Association’s (AHA) Life's Essential 8 (LE8) model, were associated with a lower risk of HDP (eg, preeclampsia, gestational hypertension) regardless of participants’ genetic risk profile.¹

The data were presented at the AHA’s Hypertension Scientific Sessions 2024, held September 5-8, in Chicago, Illinois.

“What was really interesting about our findings was how cardiovascular health in the first trimester appeared to be protective for all,” presenting author Vineetha Mathew, a fourth-year medical student at Tufts University School of Medicine in Boston, said in an AHA news release.² “We saw that the odds of developing a hypertensive disorder of pregnancy among those with a high genetic risk combined with favorable cardiovascular health was comparable or even better than those with low genetic risk but unfavorable cardiovascular health.”

According to Mathew and colleagues, HDP are a leading cause of maternal and perinatal mortality. Polygenic risk scores are used to predict a women’s genetic risk for developing HDP, but it is unclear the extent to which CVH modifies this risk.¹

“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,” Mathew said in the release.²

Investigators examined genotyped participants of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b), conducted between 2010 and 2013. Individual HDP genetic risk was calculated using a validated polygenic score and a composite first-trimester CVH scoring system was adapted from the AHA’s LE8.¹

Seven out of the 8 components of the LE8 (diet, physical activity, sleep, nicotine exposure, diabetes, baseline blood pressure, and body mass index [BMI]) were incorporated into the CVH score. Cholesterol levels were not available for all participants, so researchers conducted a secondary analysis of a subset (47%) of women with available cholesterol measures in the first-trimester. Using these scores, each woman’s CVH was classified as favorable or unfavorable.^1,2

Researchers adjusted their analysis of the association between CVH and genetic risk and HDP for age, self-reported race and ethnicity, education level, and marital status, according to the press release.²

Findings

Among the 5446 participants (mean age, 27.5 years) included in the study, 1339 (24.6%) developed HDP, including preeclampsia (n=344) and gestational hypertension (n=995), according to the study abstract.¹

Results showed that a higher genetic risk and lower CVH were additively associated with risk of HDP with no significant interaction (P for interaction > .05). Compared to women with unfavorable CVH (ie, those with the lowest LE8 score), participants with favorable CVH had a 35% to 62% lower risk of developing HDP across all genetic risk groups. The incidence of HDP ranged from 11% among participants with low genetic risk and favorable CVH to 37% among those with a high genetic risk and unfavorable CVH. In addition, among the CVH components, nonideal BMI, blood pressure, and diet contributed most to HDP risk (25%, 14%, and 12%, respectively), according to investigators.¹

These findings were broadly consistent after Mathew and colleagues examined preeclampsia and gestational hypertension separately and when incorporating cholesterol values in the subset of participants.¹

“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 in the AHA release.² “Prevention is becoming the forefront of medicine,” she added, recommending that women, “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.”

The main limitation to the current study is the lack of cholesterol metrics for nearly half of the cohort, so more studies are needed that involve a more diverse population and incorporate CVH metrics throughout pregnancy and risk patterns in subsequent pregnancies.²

References:

1. Mathew V, Patel A, Cho SM, et al. Cardiovascular health modifies genetic risk for the hypertensive disorders of pregnancy. Abstract presented at the AHA Hypertension Scientific Sessions 2024; September 5-8, 2024; Chicago, Illinois.
2. Better cardiovascular health in early pregnancy may offset high genetic risk. News item. American Heart Association. September 7, 2024. Accessed September 17, 2024. https://newsroom.heart.org/news/better-cardiovascular-health-in-early-pregnancy-may-offset-high-genetic-risk