PE/GHTN linked to higher frequency of cardiovascular and metabolic abnormalities

In a study to be presented on Feb. 5 in an oral concurrent session at 2:45 p.m. PST, at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting™, in San Diego, researchers of the MFMU Network will present findings of long term cardiovascular and metabolic abnormalities five to ten years later in women with preeclampsia/gestational hypertension during pregnancy.

The study, titled Adverse Pregnancy Outcomes and Subsequent Metabolic Syndrome analyzed 825 women who were followed up approximately seven years after their delivery. At the time of enrollment in the original study, the women were pregnant and had mild gestational diabetes or lesser degrees of abnormal glucose values, but did not have a prior history of gestational diabetes mellitus or diabetes, chronic hypertension or renal or cardiovascular disease. At follow-up, women had anthropometric and blood pressure measurements, provided blood for laboratory measurements and were asked about medications and diet. A majority of the women were noted to have high waist circumference and low HDL-C at follow up.

The research concluded that in an obstetric population with no preexisting conditions, and no or only mild GDM in the index pregnancy, pregnancy associated hypertension, particularly when delivery occurred preterm, was associated with a higher frequency of subsequent hypertension and metabolic syndrome in the mother five to ten years later.

"This study provides additional support of the concept of pregnancy as a window to future health and the need for physicians to continue to monitor and counsel patients with conditions such as preeclampsia and gestational hypertension, especially if its onset was early or if the woman also delivered preterm," stated Madeline Rice, Ph.D., of the Milken Institute School of Public Health at the George Washington University, on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network in Bethesda, Md.

Abstract 33: Adverse Pregnancy Outcomes and Subsequent Metabolic Syndrome

Author: Madeline Rice1 1for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD

Objective: To evaluate whether preeclampsia/gestational hypertension (PE/GHTN) and preterm birth (PTB) are associated with maternal metabolic syndrome (MetSyn) later in life.

Study Design: Women enrolled in a mild gestational diabetes mellitus (GDM) treatment trial (abnormal oral glucose tolerance test (OGTT); fasting glucose <95 mg/dl) and a concurrent observational non-GDM cohort (abnormal 50 g screen; normal OGTT) were followed up 5-10 years later. Women did not have a prior history of GDM or diabetes, chronic hypertension, or renal or cardiovascular disease at the time of enrollment in the studies. At follow-up, women had anthropometric and blood pressure measurements, provided blood for central laboratory measurements, and were asked about medications and diet. MetSyn was defined as three or more of the following: high waist circumference (>88 cm), high triglycerides (?150 mg/dL), low high density lipoprotein cholesterol (HDL-C) (<50 mg/dL), blood pressure ?130/85 mmHg, or fasting glucose ?100 mg/dL (or relevant treatment for any of these components).

Results: This analysis included 824 women (46% of eligible women from the original studies) who were followed up 7±1 years after the index pregnancy and were not pregnant at the time of follow-up. Mean age at follow-up was 36±6 years. Overall, 29% had MetSyn (33% in those with GDM and 24% in those without GDM; p=.005). High waist circumference and low HDL-C was observed in the majority of women. The frequency of MetSyn, and its components, was highest in the women who were delivered preterm and had PE/GHTN. After adjusting for confounding factors, PE/GHTN with or without PTB was significantly associated with subsequent hypertension and PE/GHTN with PTB was significantly associated with subsequent MetSyn.

Conclusion: In an obstetric population with no preexisting conditions, and no or only mild GDM in the index pregnancy, PE/GHTN, particularly when delivery occurred preterm, was associated with a higher frequency of long term cardiovascular and metabolic abnormalities in the mother 5-10 years later.