Study shows adverse pregnancy outcomes increase risk of maternal cardiovascular disease in the postpartum period

A pregnant person consulting with a doctorThe United States has the highest rates of maternal mortality in the developed world. Changing women’s cardiovascular health prioritizes the focus of physicians and researchers on pregnancy, maternal health and cardiovascular disease at The Ohio State University College of Medicine.

A recent study by Kartik Venkatesh, MD, PhD, assistant professor of Obstetrics and Gynecology at the Ohio State College of Medicine and Director of the Diabetes in Pregnancy Program at The Ohio State University Wexner Medical Center, and his team showed that individuals who experienced adverse pregnancy outcomes (APOs) in their first birth were more likely to have a higher predicted risk of atherosclerotic cardiovascular disease (CVD) over the following three decades, when measured two to seven years after delivery. Atherosclerotic CVD is a condition where the arteries become narrowed and hardened due to buildup of plaque in the artery wall and can cause heart attack or stroke. The results were just published in the journal Obstetrics & Gynecology.

“There was a dose-response relationship between the number of adverse pregnancy outcomes and the degree of atherosclerotic CVD risk,” Dr. Venkatesh says. “Continued risk assessment and engagement in preventive care after an adverse pregnancy outcome remain important opportunities to reduce atherosclerotic CVD risk and improve maternal health in the postpartum period.”

APOs include gestational diabetes mellitus, hypertensive disorders of pregnancy including preeclampsia, preterm birth and abnormal birth weight, including both small and large-for-gestational-age. Since they occur in individuals of reproductive age who are in early-to-mid-adulthood, the aim is to ensure primary and secondary preventive strategies aimed at cardiometabolic risk factors, such as obesity, substance use, hypertension, diabetes, and lifestyle factors, that can alter the trajectory of CVD risk.

Laxmi Mehta, MD, clinical professor of Internal Medicine at the Ohio State College of Medicine and cardiologist at The Ohio State University Wexner Medical Center, says this research drives home the fact that a lot of women are unaware that having any of these issues during pregnancy puts them at a higher risk of developing heart disease in the future. She believes making maternal health a priority in programming, education, research and policy development starts with making sure patients know their important heart health numbers — blood pressure, glucose and cholesterol numbers — before, during and after pregnancy.

Dr. Mehta served as chair of a committee at the American Heart Association that drafted a recent scientific statement on cardiovascular disease in pregnancy for childbearing-aged women in the U.S. Her work across interdisciplinary team centers comprehensive cardiovascular health because being pregnant can put a lot of stress on the body, especially the heart.

The new research contributes to a greater understanding of how adverse pregnancy outcomes are an important contributor to cardiovascular disease in women later in life and emphasizes the importance of pregnancy health for women’s heart health.

“The link between adverse pregnancy outcomes and CVD should be a core knowledge area for all cardiovascular, primary care and obstetrics and gynecology providers,” Dr. Venkatesh says. “Providers and patients working together after an adverse pregnancy outcome can help identify ways to improve heart health decades before the onset of disease.”

This work emphasizes recent efforts underway to highlight the need to address women’s cardiovascular health across the lifespan, including the recently launched White House Initiative on Women’s Health Research. This initiative aims to change how women’s health research is approached and funded and launch new discoveries and innovations on women’s health.