Pregnant women who have persistent BP rises in the upper ranges of normal may face increased risk for developing metabolic syndrome and higher CV risk after giving birth, according to findings published in Hypertension.
“Our findings underscore an important issue that has long been ignored in clinical practice — the fact that criteria for hypertension in pregnancy are derived from the general population,” Jian-Min Niu, MD, department of obstetrics, Guangdong Women and Children Hospital, China, said in a press release. “We anticipate that if reaffirmed in further research, our study could spark a change in what we currently deem healthy [BP] in pregnant women.”
Researchers sought to study the associations between pregnancy BP strata and the development of metabolic syndrome.
They analyzed data from a cohort of 507 women from Guangzhou, China. Among the requirements were that the women had normal BP levels (< 140 mm Hg systolic/90 mm Hg diastolic); had normal glucose and lipid profiles; had no history of vaginal bleeding, alcohol or substance abuse; and were nonsmokers.
The original 507 participants each underwent seven or more BP evaluations during pregnancy. The cohort eventually shrank to 309 women due to data-permission issues and a 60.9% postpartum follow-up rate over 1.6 years. In addition, glucose and lipid levels were evaluated from study entry through follow-up.
Researchers stratified the cohort according to three diastolic BP trajectory categories: a low J-shaped group (34.2%; 62.5 ± 5.8 mm Hg to 65 ± 6.8 mm Hg); a moderate U-shaped group (52.6%; 71 ± 5.9 mm Hg to 69.8 ± 6.2 mm Hg); and an elevated J-shaped group within the range of hypertension (13.2%; 76.2 ± 6.7 mm Hg to 81.8 ± 4.8 mm Hg).
The researchers found that the hypertension-range group had a 6.5 greater odds of developing postpartum metabolic syndrome than the low J-shaped group (adjusted OR = 6.55; 95% CI, 1.79-23.92).
Niu and colleagues also developed a model for prediction of postpartum metabolic syndrome that included diastolic BP (membership in the elevated J-shaped group), fasting glucose > 4.99 mmol/L and triglycerides > 3.14 mmol/L at term, which showed good calibration and discrimination (C statistic, 0.764; 95% CI, 0.674-0.855; P < .001).
They wrote, “Pregnancy is a known, long-term CV risk for women. The presence of hypertensive disorders in pregnancy is generally recognized as a maladaptation to pregnancy-induced hemodynamic and metabolic alterations.”
In the release, Niu said, “Early identification of metabolic risk factors and implementations of lifestyle modifications may help delay the onset of CVD that would present itself 20 to 30 years after [childbirth].” – by James Clark