Good heart health early in pregnancy may offset genetic risk for complications
Maintaining good cardiovascular health early in pregnancy may lower the risk for dangerous high blood pressure-related health conditions, even among people at genetic risk for those problems, preliminary new research suggests.
The study found higher cardiovascular health scores, as measured by adherence to a set of health metrics, were linked to a lower risk for gestational hypertension and preeclampsia, regardless of a woman's genetic risk profile. The findings , which were presented at the American Heart Association's Hypertension Scientific Sessions in Chicago, are considered preliminary until full results are published in a peer-reviewed journal.
"What was really interesting about our findings was how cardiovascular health in the first trimester appeared to be protective for all," study coauthor Vineetha Mathew, a fourth-year medical student at Tufts University School of Medicine in Boston, said in a news release . "We saw that the odds of developing a hypertensive disorder of pregnancy among those with a high genetic risk combined with favorable cardiovascular health were comparable or even better than those with low genetic risk but unfavorable cardiovascular health."
Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, are a leading cause of death for pregnant women and newborns. Polygenic risk scores can be used to predict a woman's genetic risk for developing these conditions. Researchers in the new study wanted to know how much a woman's cardiovascular health status in early pregnancy could affect this risk.
In the study, researchers analyzed health and genetic risk data for 5,446 first-time mothers who were 27 years old on average. Cardiovascular health was measured by scoring adherence during the first trimester to the AHA's Life's Essential 8, a set of health factors and behaviors to improve and maintain good heart health that includes eating a healthy diet, staying physically active, not smoking, getting enough sleep and managing weight, cholesterol, blood glucose and blood pressure. Seven of the eight components were incorporated into the women's health scores, while cholesterol was included for just 47% of the participants.
Using these scores, each woman's cardiovascular health was classified as favorable or unfavorable. Researchers classified genetic risk using a previously validated polygenic risk score, which estimates a person's susceptibility to disease based on aggregated data for millions of genetic variants.
Women with the highest cardiovascular health scores (not including cholesterol) had a 35% to 62% lower risk of developing pregnancy-related hypertensive disorders across all genetic risk groups. The lowest rate (11%) of such disorders occurred among those with low genetic risk and favorable cardiovascular health, while the highest rate (37%) occurred among people with high genetic risk and unfavorable cardiovascular health.
The biggest factors contributing to hypertensive disorders during pregnancy were higher body mass index, high blood pressure and poor diet. The results remained broadly consistent after incorporating cholesterol into the cardiovascular health score for a subset of 2,560 women and when looking at gestational hypertension and preeclampsia separately.
Mathew said the findings underscore the importance of cardiovascular health counseling before and during early pregnancy. She advised OB-GYN and primary care professionals to emphasize cardiovascular health, healthier nutrition, weight management and maintaining healthy blood pressure for their patients who are considering pregnancy.
"Prevention is becoming the forefront of medicine," she said. "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 findings in the new study highlight "the importance of the cardiovascular health construct ... across the entire life course, including during pregnancy," Dr. Donald M. Lloyd-Jones said in the release. Lloyd-Jones, who was not involved in the study, is chair of the department of preventive medicine and a professor of preventive medicine, medicine and pediatrics at Northwestern University's Feinberg School of Medicine in Chicago.
"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," said Lloyd-Jones, who helped develop Life's Essential 8.
"It is particularly notable that high cardiovascular health scores, achievable through a focus on healthy lifestyle, may help mitigate the risk conferred by a person's genes," he said.
