Abstract Body (Do not enter title and authors here): Background
Hypertensive disorders of pregnancy (HDP) are on the rise and are major contributors to adverse maternal and neonatal outcomes in the US. Cardiac and angiogenic biomarkers—such as high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), placental growth factor (PIGF), and the sFlt-1/PIGF ratio—are implicated in HDP pathophysiology. However, the clinical factors influencing these biomarkers, particularly PIGF, are not well understood. While excessive gestational weight gain (GWG) is known to be associated with HDP, the impact of GWG on these biomarkers in pregnancy is unknown.
Research Question
Is excessive gestational weight gain in pregnancy associated with higher serum levels of cardiac biomarkers (hs-cTnI, NT-proBNP, hs-CRP, PIGF, sFlt-1/PIGF ratio)?
Methods
A case-control study was conducted from July 2019 to February 2022 at a large, tertiary care academic center. Participants were pregnant with singleton pregnancies with and without hypertension between 24–32 weeks of gestation. Demographic and clinical data, including pre-pregnancy body mass index (BMI) and GWG were collected. Participants were categorized based as either exceeding or meeting the Institute of Medicine GWG guidelines. Blood samples for biomarker measurements were collected on admission for delivery for biomarker analysis. Mixed-effects logistic regression models, adjusted for age, race, hypertension status, and BP control during early pregnancy were used to assess associations between GWG and elevated biomwearker levels.
Results
Among 75 participants (mean age 32), 66.7% were non-Hispanic White, and 46.7% had pre-pregnancy obesity(Table 1) and 32% exceeded IOM GWG recommendations, while 49.3% had hypertension. Excessive GWG was significantly associated with elevated hs-cTnI (OR 6.17; 95% CI 1.33–28.54; p = 0.02) and NT-proBNP (OR 19.81; 95% CI 1.89–207.77; p = 0.01. No significant associations were found with PIGF, hs-CRP, or the sFlt-1/PIGF ratio.
Conclusion
Excessive GWG was significantly associated with elevated levels of hs-cTnI and NT-proBNP in late pregnancy. This suggests excessive weight gain in pregnancy may be associated with higher levels of cardiac strain and injury. Larger, prospective studies may be helpful in further exploring the role of excessive GWG and these cardiac and angiogenic markers in early HDP risk stratification.