GREENVILLE — A cohort study linked better cardiovascular health during pregnancy with a longer time to incident cardiometabolic conditions over seven years. Ellen Francis, PhD, of the Rutgers School of Public Health in Piscataway, New Jersey, and colleagues reported the findings in JAMA Network Open.

The study utilized a modified pregnancy-specific version of the 'Life's Essential 8' heart-health checklist. For every 10-point increase in the modified score, there was a longer time to incident diagnosis of chronic hypertensive conditions, with a time ratio of 1.26 (95% CI 1.11-1.42). Each 10-point increase in the modified score was also linked to a longer time to incident diagnosis of chronic metabolic conditions, with a time ratio of 1.20 (95% CI 1.11-1.29).

Better scores related to hypertensive disorders of pregnancy, glucose, body mass index, and sleep were associated with a longer time to diagnosis of a chronic metabolic condition. Specifically, longer time to diagnosis of chronic metabolic conditions was associated with better component scores for hypertensive disorders of pregnancy (TR 1.06 per 10-point increase), glucose (TR 1.15), BMI (TR 1.07), and sleep (TR 1.05). Associations were not found for smoking, physical activity, or diet in this study. "Poorer cardiovascular health was associated with subsequent hypertensive and metabolic conditions even among women without gestational diabetes or a hypertensive disorder of pregnancy," Francis said.

The analysis stemmed from a cohort study conducted across a large academic medical system in Greenville, South Carolina, enrolling participants from the Cradle randomized trial. Eligible patients were between the ages of 14 and 45 with a singleton pregnancy not yet delivered. The study excluded patients with major medical comorbidities or conditions, such as preexisting diabetes or cardiovascular disease. Demographic, lifestyle, and stress surveys were conducted at enrollment, when patients were at 20 weeks' gestation or earlier, and again during the third trimester. Blood was drawn during the second trimester for tests.

Follow-up commenced seven days post-delivery or, for those who miscarried or missed their delivery date, on the expected delivery date. Among 1,225 pregnancies, 499 incident cardiometabolic events occurred over a median follow-up of 6.2 years. The primary outcome was post-delivery incident cardiometabolic conditions, which were identified through electronic medical records. "Pregnancy complications are important indicators of future risk, but relying on those diagnoses alone may miss women whose cardiovascular health is already less favorable," Francis said. "A broader assessment could potentially identify additional women who may benefit from prevention and health-promotion services after delivery."

Limitations noted by Francis and her team included that diagnosis dates in electronic medical records might not reflect the true biological onset of conditions. Participants who delivered later in the study also had less observable follow-up time. The possible misclassification of self-reported outcomes was noted as another limitation. The authors indicated that validation studies and further research are needed to translate this type of assessment into improved health outcomes through specific interventions.