Abstract TH984: Adverse gestational outcomes elevate risk of cardiac and vascular dysfunction in pre-menopausal women

Abstract

Introduction: Pregnancy is considered the ultimate stress test on the body, as it may reveal or accelerate underlying cardiovascular risks in women. Existing studies have focused on the postmenopausal phase linking adverse pregnancy outcomes and menopausal symptoms to cardiovascular risk. However, the pre-menopausal phase is crucial for early signs of cardiovascular dysfunction. This study aims to evaluate the association between adverse pregnancy outcomes and cardiac structure and vascular function in pre or peri menopausal women. Methods: This study leverages data from a longstanding study of Black and White women enrolled in childhood and followed to their mid-40s. Women self-reported adverse pregnancy outcomes in one or more pregnancies, including preterm birth and hypertensive disorders of pregnancy (HDPs: gestational hypertension and pre-eclampsia/eclampsia). Women who never gave birth were included in the ‘no’ group. Left ventricular mass indexed to height 2.7 (LVMI), from echocardiography and pulse wave velocity (PWV) were used as measures of cardiac structure and vascular function. Linear regression analysis was used to determine relationships between cardiac and vascular assessments and each adverse pregnancy outcome, adjusting for lean mass index (LMI) and current systolic blood pressure (SBP). Results: Data from a total of 147 women (45.5 ± 3.9 years) were analyzed, where 30 (25.6%) reported preterm birth and 21 (19.7%) HDPs in one or more pregnancies. LMI and SBP were significantly associated with both LVMI and PWV (p<0.001) but race and overall parity were not. In unadjusted analyses, women with a history of preterm birth or HDP had significantly higher LVMI (mean difference ± SE: 4.36 ± 2.08 g/m 2.7 , p=0.04 and 4.70 ± 2.12 g/m 2.7 , p=0.03, respectively) and higher current SBP (difference: 6.84 ± 3.15 mmHg, p=0.03 and 11.8 ± 3.07 mmHg, p=0.0002, respectively) compared to those who did not. Adjusting for LMI and SBP, the relationships between preterm birth and HDP with LVMI were attenuated (both p=0.07). PWV was not associated with history of HDP or preterm birth. Conclusions: Pre or peri menopausal women with histories of preterm birth or HDPs may be at risk for increased left ventricular mass. Closer post-pregnancy monitoring of women with a history of preterm birth or HDP may help prevent later cardiovascular outcomes.