Favorable Cardiovascular Health in Early Pregnancy Linked to Lower Risk of Hypertensive Disorders

A new study presented at the American Heart Association's Hypertension Scientific Sessions 2024 suggests that maintaining good cardiovascular health during the first trimester of pregnancy may help offset the genetic risk of developing preeclampsia and gestational hypertension. These findings underscore the importance of early cardiovascular health counseling for individuals considering pregnancy.

The research, conducted by a team including Vineetha Mathew, a fourth-year M.D. candidate at Tufts University School of Medicine, analyzed data from over 5,000 first-time pregnant individuals. The study utilized the American Heart Association's Life's Essential 8 (LE8) scoring to measure cardiovascular health status in early pregnancy.

Researchers found that favorable cardiovascular health was associated with a 35% to 62% lower risk of developing a hypertensive disorder of pregnancy across all genetic risk groups. The incidence of these disorders ranged from 11% in individuals with low genetic risk and favorable cardiovascular health to 37% in those with high genetic risk and unfavorable cardiovascular health.

Mathew emphasized the protective nature of first-trimester cardiovascular health for all participants, noting 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."

The study identified body mass index, blood pressure, and diet as the most significant contributors to the population-level risk for developing hypertensive disorders of pregnancy, accounting for 25%, 14%, and 12% of the risk, respectively.

These findings highlight the potential for preventive measures in reducing the risk of hypertensive disorders during pregnancy. The researchers stress the importance of preconception and early pregnancy cardiovascular health counseling, urging healthcare professionals to emphasize cardiovascular health improvement, healthier nutrition, weight management, and healthy blood pressure to patients considering pregnancy.

Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, chair of the writing group for the Association's Presidential Advisory unveiling Life's Essential 8, commented on the study's implications: "These results highlight the importance of the cardiovascular health construct, as measured by the American Heart Association's Life's Essential 8 score, across the entire life course including during pregnancy. The impressive reductions in risk for hypertensive disorders of pregnancy associated with higher cardiovascular health demonstrate that there is much within our control to help patients avoid these potentially lethal pregnancy complications."

The study's limitations include missing cholesterol metrics for about half the participants in the main analysis. Future research will aim to expand the study to include a more diverse population and incorporate cardiovascular health metrics throughout pregnancy, as well as risk patterns in subsequent pregnancies.

This research underscores the critical role of cardiovascular health in pregnancy outcomes and offers hope for reducing the risk of hypertensive disorders, which are a leading cause of death in both expectant mothers and newborns. By focusing on improving cardiovascular health before and during early pregnancy, healthcare providers may be able to significantly impact maternal and fetal health outcomes.