Abstract Body: Introduction: Many adverse pregnancy outcomes (APOs) associated with long-term CVD risk, such as preeclampsia, are mediated by placental function. Notably, the vascular and inflammatory placental pathology underlying APOs are also found in 20-35% of healthy pregnancies. Thus, we aimed to investigate the link between 30-year CVD risk and placental pathology.
Hypothesis: We hypothesized that higher 30-year CVD risk, as estimated based on the PREVENT equation calculated in mid-pregnancy, would be associated with greater likelihood of placental pathology, including chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM).
Methods: Data are from the Stress, Pregnancy, and Health (SPAH) study, a prospective pregnancy cohort conducted from 2018-2023 in Evanston, IL. The PREVENT 30-year CVD risk estimate was calculated based on the 2^nd trimester study visit. At the study visit, blood pressure was assessed, and a blood sample was collected and used to measure cholesterol and estimate eGFR from creatinine. Participants self-reported smoking status. Age, pre-gestational diabetes diagnosis, and use of anti-hypertensive or lipid-lowering medications were abstracted from medical records. Following delivery, placentas were collected and reviewed by a perinatal pathologist and patterns of placental injury (CI, MVM, FVM) were identified based on Amsterdam consensus criteria. Logistic models were used to test associations between CVD risk in pregnancy and placental pathology, adjusted for race/ethnicity, socioeconomic position, and gestational age at the study visit.
Results: The SPAH study included 605 participants, 505 of whom had placental pathology exams and complete data to estimate 30-year CVD risk during pregnancy. The mean gestational age at the study visit was 23.7 weeks (SD: 1.7) and the mean age of study participants was 33.3 years (SD: 5.6). The mean 30-year CVD risk was 7.6% (SD: 6.7) and 54% had CI, 29% had MVM, and 34% had FVM. In the adjusted model, a 1 SD increase in CVD risk was associated with 24% greater odds of having CI (95% CI: 1.01, 1.52) and 25% greater odds of having MVM (95% CI: 1.04, 1.50; Figure 1) at delivery. CVD risk was not associated with FVM.
Conclusions: Results demonstrate that PREVENT 30-year CVD risk estimated in the second trimester is associated with CI and MVM in the placenta at delivery, which may provide insight into the mechanisms linking CVD risk and APOs.