Pregnancy complications that include preeclampsia, gestational hypertension, preterm birth (<37 weeks gestation), and low birthweight (<5.5 lb) serve as possible indicators for greater risk of early heart failure (HF) in the long term, as indicated by change in global longitudinal strain (GLS) on echocardiogram (EKG). GLS is a measure of the heart’s pumping ability.
Study results from the Coronary Artery Risk Development in Young Adults (CARDIA) study presented during the ACC.20/WCC Virtual Experience demonstrate that women who have a pregnancy complication, or adverse pregnancy outcome (APO), may subsequently experience a worsening in their heart function, chiefly their GLS as measured after 30 years of follow-up.
“There is emerging evidence that what happens during pregnancy may be a window into a woman’s future cardiovascular health, but there are still important knowledge gaps about the early trajectory following pregnancy complications and structural changes that happen before someone has an event,” stated Priya Mehta, MD, a cardiology fellow at Northwestern University in Chicago and the study’s lead author.
Study enrollment took place from 1985 to 1986, and the women had a mean (SD) age of 24.3 (3.6) years; 47% were black. In an abstract presented at the conference of 936 women from CARDIA, 1 in 3 (35%; 330/936) women were shown to have self-reported at least one of the APOs mentioned above through a mean 1.8 (0.9) births, and abnormal heart function changes were more likely to be seen on their EKGs. These women who had abnormal EKGs also had risk factors that included higher body mass index and blood pressure (BP).
Adjustments were made for both pre- and postpregnancy risk factors, but GLS remained lower—worse by almost 1%—in the women who experienced an APO, especially among those who had a low-birthweight child. According to the study authors, this is a “magnitude of difference that has been shown in other studies to be associated with an increased risk for incident heart failure.” It also indicates the possibility of low birthweight being an “independent sex-specific risk factor for HF.” Whereas with preeclampsia and gestational hypertension, the greater risk of HF could be explained by the greater rates of high BP, obesity, and diabetes the women subsequently developed.
Mehta stresses the need for further research on the connection between APOs and early heart disease, which is an area of study seemingly pushed aside.
“Even though pregnancy complications have been included in some cardiovascular disease prevention recommendations and are named as a risk enhancer in the [American College of Cardiology/American Heart Association] primary prevention guideline, there needs to be more intensive surveillance and screening. We are missing women at high cardiovascular risk if we don’t make it routine practice to take adverse pregnancy outcomes into account when we inquire about patients’ cardiovascular history,” she cautioned.
An important study limitation was that the APOs were self-reported. Moving forward, the study authors recommend using medical records to confirm their occurrence.
Mehta PP, Colangelo L, Lane-Cordova A, et al. Adverse pregnancy outcomes and mid-life cardiac mechanics: the Coronary Artery Risk Development in Young Adults study. Presented at: ACC.20/WCC Virtual; March 28-30, 2020; Chicago, IL. onlinejacc.org/content/75/11_Supplement_2/11. Accessed March 27, 2020.