Abstract Body: Background: Studies about the association between the adverse pregnancy outcomes (APO) and cardiac structure and function in midlife are scarce despite evidence that APO increases the risk of cardiovascular disease in later life.
Objectives: The current study aims to investigate the association of APO with left ventricular (LV) structure and function after follow-up of approximately 15 years post-pregnancy.
Methods: The Bogalusa Heart Study (BHS) is an ongoing rural community-based cohort in Louisiana. We examined 454 women who experienced singleton pregnancies and had follow-up echocardiography performed post-pregnancy. APO included pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preterm birth, and miscarriage at any pregnancy. Echocardiographic parameters at follow-up included LV ejection fraction (LVEF), LV mass index (LVMi), and LV geometry. LV geometry was classified as normal, concentric remodeling, concentric and eccentric hypertrophy. Multivariable linear and logistic regression analyses were applied and adjusted for age, race, education, smoking, alcohol intake, systolic blood pressure, fasting blood glucose, and total cholesterol. Interactions by age and race were tested.
Results: The mean age across any pregnancy was 23.0 ± 5.6 years, and 33.7% were Black. After a median follow-up period of 15.1 years, in adjusted analyses, preterm birth and miscarriage were not statistically associated with LVEF, LVMi, and LV geometry. However, PIH (β coefficient = 0.12; p = 0.014) was associated with greater LVMi in midlife, but not with LVEF or LV geometry. GDM was associated with LV geometry, specifically with an increased risk of concentric hypertrophy (Odds Ratio, 3.42; 95% Confidence Interval, 1.04-11.30; p = 0.044). Interactions by race and age were not statistically significant.
Conclusion: We identified the association of APO, specifically PIH and GDM, with greater subsequent LVMi and concentric remodeling 15 years later. Further studies are warranted to replicate these findings; however, women with PIH and GDM might be at higher risk of heart disease later in life.
Keywords: Adverse pregnancy outcome, pregnancy induced hypertension, echocardiography, left ventricular mass index