Association between infant birth weight, preterm delivery and maternal cardiovascular risk in the Health, Aging and Body Composition Study

Mothers who deliver a low birth weight infant may themselves be at excess risk for cardiovascular disease. We validated maternal recall of infant birth weight after an average follow up of 57 years, and investigated whether older women who reported having delivered low birth weight (LBW) infants (<2500 g) had later elevations in cardiovascular risk factors and were at increased risk for clinical cardiovascular disease. Participants were 446 women (mean age 80 years; 47% black) enrolled in The Health, Aging and Body Composition Study. Women reported birth weight and selected complications for each pregnancy, and pregnancies complicated by hypertension or preeclampsia were excluded. We found strong correlation between recalled and documented birth weights for first births (ICC=0.96) in a randomly selected group of participants, and reliability of recall for first births remained high when considered separately by race, education, income and age. Women who had reported a LBW first birth had a lower current BMI (adjusted for race and age) compared to women with normal weight infants (26.6 vs. 28.0 kg/m²; p=0.057), but they had a higher abdominal circumference (98.1 vs. 95.0 cm; p=0.007). After adjustment for BMI, race and age, women with a history of a LBW vs. normal weight infant had elevated systolic blood pressures (p=0.048) despite higher use of anti-hypertensive medication (p=0.061). Women with LBW infants also had higher levels of IL-6 (p=0.021), fasting insulin (p=0.064), and triglycerides (p=0.071), and they were more insulin resistant (p=0.045) compared to women with a normal weight infant. Women who delivered preterm infants had an elevated risk for cardiovascular disease at age 80 (adjusted odds ratio=2.77, 95% CI 1.06-7.24) compared to women who delivered term infants. Women who had delivered infants both LBW and preterm had markedly elevated cardiovascular risk factors when compared to women with normal weight term infants, and appeared to have the highest risk for clinical cardiovascular disease (adjusted odds ratio=4.21, 95% CI 1.23-14.45). The public health importance of these findings is that a history of LBW or preterm delivery may identify women who would benefit from screening and intervention aimed at risk factors for cardiovascular disease

Re: Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: The POUCHmoms longitudinal study Potential mechanism for pregnant and nonpregnant hypertension

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141906/1/bjo14921.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141906/2/bjo14921_am.pd

Re: Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: The POUCHmoms longitudinal study Potential mechanism for pregnant and nonpregnant hypertension

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141906/1/bjo14921.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141906/2/bjo14921_am.pd

Maternal hypertension after a low-birth-weight delivery differs by race/ethnicity: Evidence from the National Health and Nutrition Examination Survey (NHANES) 1999-2006

Studies have suggested an increase in maternal morbidity and mortality due to cardiovascular diseases in women with a prior low-birth-weight (LBW, <2,500 grams) delivery. This study evaluated blood pressure and hypertension in women who reported a prior preterm or small-for-gestational-age (SGA) LBW delivery in the National Health and Nutrition Examination Survey 1999-2006 (n = 6,307). This study also aimed to explore if race/ethnicity, menopause status, and years since last pregnancy modified the above associations. A total of 3,239 white, 1,350 black, and 1,718 Hispanics were assessed. Linear regression models were used to evaluate blood pressure by birth characteristics (preterm-LBW, SGA-LBW, and birthweight ≥2,500). Logistic regression models estimated the odds ratios (OR) of hypertension among women who reported a preterm-LBW or SGA-LBW delivery compared with women who reported an infant with birthweight ≥2,500 at delivery. Overall, there was a positive association between a preterm-LBW delivery and hypertension (adjusted OR = 1.39, 95% confidence interval (CI) 1.02-1.90). Prior SGA-LBW also increased the odds of hypertension, but the estimate did not reach statistical significance (adjusted OR = 1.21, 95% CI 0.76-1.92). Race/ethnicity modified the above associations. Only black women had increased risk of hypertension following SGA-LBW delivery (adjusted OR = 2.09, 95% CI 1.12-3.90). Black women were at marginally increased risk of hypertension after delivery of a preterm-LBW (adjusted OR = 1.49, 95% CI 0.93-2.38). Whites and Hispanics had increased, but not statistically significant, risk of hypertension after a preterm-LBW (whites: adjusted OR = 1.39, 95% CI 0.92-2.10; Hispanics: adjusted OR = 1.22, 95% CI 0.62-2.38). Stratified analysis indicated that the associations were stronger among women who were premenopausal and whose last pregnancy were more recent. The current study suggests that in a representative United States population, women with a history of preterm- or SGA-LBW deliveries have increased odds of hypertension and this risk appears to be higher for black women and younger women. © 2014 Xu et al

Number of Offspring and Cardiovascular Disease Risk in Men and Women: The Role of Shared Lifestyle Characteristics

Previous studies of the number of offspring and cardiovascular disease (CVD) report conflicting findings. We re-examined this association in both sexes to clarify the role of the cardiometabolic changes that women experience during pregnancy versus shared lifestyle characteristics. We studied 180,626 women and 133,259 men participating in the UK Biobank cohort who were free of CVD at baseline. CVD events were obtained from hospital and death registers. Analyses were conducted using Cox proportional hazards regression. The incidence rates of overall CVD were 6 per 1,000 person years for women and 9 per 1,000 person years for men. Number of children showed an association with risk of CVD among women; the adjusted HR (95% CI) was 1.2 (1.1, 1.3) for one, 1.1 (1.0, 1.2) for two, 1.2 (1.1, 1.3) for three and 1.2 (1.1, 1.4) for four or more as compared to none. Number of children was also associated with CVD among men; the adjusted HR (95% CI) was 1.1 (1.0, 1.2) for one, 1.0 (0.96, 1.1) for two, 1.1 (1.0, 1.2) for three and 1.1 (1.0, 1.3) for four or more as compared to none. There was no evidence of heterogeneity in the associations between sexes (p-value interaction 0.80). Number of offspring showed similar associations with ischemic heart disease and hypertensive disorders in both sexes. We observed similar associations between number of offspring and CVD in both sexes. The association among women might therefore be largely explained by unobserved behavioral and lifestyle characteristics

Evidence from the National Health and Nutrition Examination Survey (NHANES) 1999-2006

Abstract Studies have suggested an increase in maternal morbidity and mortality due to cardiovascular diseases in women with a prior low-birth-weight (LBW, ,2,500 grams) delivery. This study evaluated blood pressure and hypertension in women who reported a prior preterm or small-for-gestational-age (SGA) LBW delivery in the National Health and Nutrition Examination Survey 1999Survey -2006. This study also aimed to explore if race/ethnicity, menopause status, and years since last pregnancy modified the above associations. A total of 3,239 white, 1,350 black, and 1,718 Hispanics were assessed. Linear regression models were used to evaluate blood pressure by birth characteristics (preterm-LBW, SGA-LBW, and birthweight $2,500). Logistic regression models estimated the odds ratios (OR) of hypertension among women who reported a preterm-LBW or SGA-LBW delivery compared with women who reported an infant with birthweight$2,500 at delivery. Overall, there was a positive association between a preterm-LBW delivery and hypertension (adjusted OR = 1.39, 95% confidence interval (CI) 1.02-1.90). Prior SGA-LBW also increased the odds of hypertension, but the estimate did not reach statistical significance (adjusted OR = 1.21, 95% CI 0.76-1.92). Race/ethnicity modified the above associations. Only black women had increased risk of hypertension following SGA-LBW delivery (adjusted OR = 2.09, 95% CI 1.12-3.90). Black women were at marginally increased risk of hypertension after delivery of a preterm-LBW (adjusted OR = 1.49, 95% CI 0.93-2.38). Whites and Hispanics had increased, but not statistically significant, risk of hypertension after a preterm-LBW (whites: adjusted OR = 1.39, 95% CI 0.92-2.10; Hispanics: adjusted OR = 1.22, 95% CI 0.62-2.38). Stratified analysis indicated that the associations were stronger among women who were premenopausal and whose last pregnancy were more recent. The current study suggests that in a representative United States population, women with a history of preterm-or SGA-LBW deliveries have increased odds of hypertension and this risk appears to be higher for black women and younger women

History of Adverse Pregnancy Outcomes, Blood Pressure, and Subclinical Vascular Measures in Late Midlife: SWAN (Study of Women’s Health Across the Nation)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142563/1/jah32800_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142563/2/jah32800.pd

Patterns of leisure-time physical activity across pregnancy and adverse pregnancy outcomes

Background Although leisure-time physical activity (PA) contributes to overall health, including pregnancy health, patterns across pregnancy have not been related to birth outcomes. We hypothesized that women with sustained low leisure-time PA would have excess risk of adverse pregnancy outcomes, and that changing patterns across pregnancy (high to low and low to high) may also be related to risk of adverse pregnancy outcomes. Methods Nulliparous women (n = 10,038) were enrolled at 8 centers early in pregnancy (mean gestational age in weeks [SD] = 12.05 [1.51]. Frequency, duration, and intensity (metabolic equivalents) of up to three leisure activities reported in the first, second and third trimesters were analyzed. Growth mixture modeling was used to identify leisure-time PA patterns across pregnancy. Adverse pregnancy outcomes (preterm birth, [PTB, overall and spontaneous], hypertensive disorders of pregnancy [HDP], gestational diabetes [GDM] and small-for-gestational-age births [SGA]) were assessed via chart abstraction. Results Five patterns of leisure-time PA across pregnancy were identified: High (35%), low (18%), late decreasing (24%), early decreasing (10%), and early increasing (13%). Women with sustained low leisure-time PA were younger and more likely to be black or Hispanic, obese, or to have smoked prior to pregnancy. Women with low vs. high leisure-time PA patterns had higher rates of PTB (10.4 vs. 7.5), HDP (13.9 vs. 11.4), and GDM (5.7 vs. 3.1, all p < 0.05). After adjusting for maternal factors (age, race/ethnicity, BMI and smoking), the risk of GDM (Odds ratio 2.00 [95% CI 1.47, 2.73]) remained higher in women with low compared to high patterns. Early and late decreasing leisure-time PA patterns were also associated with higher rates of GDM. In contrast, women with early increasing patterns had rates of GDM similar to the group with high leisure-time PA (3.8% vs. 3.1%, adjusted OR 1.16 [0.81, 1.68]). Adjusted risk of overall PTB (1.31 [1.05, 1.63]) was higher in the low pattern group, but spontaneous PTB, HDP and SGA were not associated with leisure-time PA patterns. Conclusions Sustained low leisure-time PA across pregnancy is associated with excess risk of GDM and overall PTB compared to high patterns in nulliparous women. Women with increased leisure-time PA early in pregnancy had low rates of GDM that were similar to women with high patterns, raising the possibility that early pregnancy increases in activity may be associated with improved pregnancy health. Trial registration Registration number NCT02231398