Preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2024 suggests that maintaining good cardiovascular health during the first trimester of pregnancy may help reduce the genetic risk of developing preeclampsia and gestational hypertension. The conference, held in Chicago from September 5-8, 2024, focuses on recent advances in research related to high blood pressure and its connections to cardiovascular and kidney diseases, stroke, obesity, and genetics.
Hypertensive disorders during pregnancy, including gestational hypertension and preeclampsia, are significant contributors to maternal and neonatal mortality. A validated tool known as a polygenic risk score can predict an individual’s likelihood of developing these conditions based on their genetic makeup. However, the influence of cardiovascular health in early pregnancy, assessed using the American Heart Association’s Life’s Essential 8 (LE8) scoring system, on this genetic risk remains unclear.
“We aimed to investigate whether cardiovascular health during early pregnancy could influence the risk of developing hypertensive disorders, even among those with varying genetic predispositions,” said Vineetha Mathew, a fourth-year M.D. candidate at Tufts University School of Medicine and coauthor of the study. “Our findings indicate that improved cardiovascular health in the first trimester may help mitigate the risk of adverse pregnancy outcomes across all genetic risk groups.”
The study analyzed data from over 5,000 first-time mothers to assess the incidence of hypertensive disorders during pregnancy. Researchers classified participants’ genetic risk using a validated polygenic risk score that estimates disease susceptibility based on the cumulative effect of millions of genetic variants. Additionally, a cardiovascular health score was derived from seven of the eight components of the LE8 (diet, physical activity, sleep, nicotine exposure, diabetes, baseline blood pressure, and body mass index) to evaluate participants’ health status. Cholesterol levels were included for a subgroup of participants (47%) for whom this data was available.
Among the LE8 components, a higher body mass index, elevated blood pressure, and poor dietary habits were found to contribute most significantly to the population-level risk for hypertensive disorders, accounting for 25%, 14%, and 12% of the risk, respectively.
“What stands out in our findings is the protective effect of cardiovascular health in the first trimester across all genetic risk levels,” Mathew noted. “Interestingly, those with high genetic risk but favorable cardiovascular health had odds of developing hypertensive disorders comparable to those with low genetic risk but unfavorable cardiovascular health.”
The study underscores the importance of cardiovascular health counseling before conception and in early pregnancy. Mathew emphasized that obstetricians and primary care providers should prioritize discussions about cardiovascular health, including nutrition, weight management, and blood pressure control, for patients considering pregnancy. “Prevention is becoming a focal point in medicine. Starting early, even before pregnancy, can significantly impact pregnancy outcomes and long-term cardiovascular health.”
The research involved 5,446 first-time mothers, with an average age of 27. The cohort was predominantly white (78%), with 11% identifying as Black and 11% as multiracial or other. Approximately 87% of participants identified as non-Hispanic, while 13% identified as Hispanic. Among the participants, about one-quarter (1,339) developed a hypertensive disorder of pregnancy, including 344 cases of preeclampsia and 995 cases of gestational hypertension.
Data were sourced from the Nulliparous (First) Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b), conducted between 2010 and 2013. Each participant was assigned a polygenic risk score reflecting their likelihood of developing hypertensive disorders. Due to missing cholesterol data for many participants, a secondary analysis included only those with available cholesterol measures.
The study was conducted in collaboration with the Broad Institute of MIT and Harvard, Massachusetts General Hospital, and Columbia University, beginning in the summer of 2023. The research was funded by the National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute.
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