(866) Mitigating pregnancy-associated atherosclerotic cardiovascular risk: the relationship between weight, adverse pregnancy outcomes, and cardiometabolic conditions

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death for women known to correlate with antecedent adverse pregnancy outcomes (APOs). Elevated BMI is also a risk factor for ASCVD, but the relationship between pregnancy-specific weight gain, APOs, and ASCVD risk is incompletely characterized.

Study Design:

We modeled BMI trajectories for first singleton births occurring from 2014-2015 at an academic medical center. Linear models were fit to the BMI course of each participant within the index pregnancy, subsequent singleton pregnancies, and last documented weight. “High ASCVD risk” individuals were identified using variables from the American College of Cardiology (ACC) ASCVD risk calculator (diabetes, hypertension, or hyperlipidemia developed before the index pregnancy and/or non-White race); those without these risk factors were coded as “Low ASCVD Risk”. Within each risk stratum, development of major cardiometabolic morbidity (MCM) after the index pregnancy was modeled with age, APO history, and geolocated poverty index.

Results:

A total of 467 subjects (872 pregnancies) were analyzed. Mean age at first pregnancy was 29.6±5.3. See Table 1 AVSC and APO status. The distribution of intra-pregnancy BMI slopes (Figure 1) shows the development of de novo risk-augmenting MCMs is associated with higher weight slope (more intra/ inter-pregnancy weight gain) in those without APOs and low preexisting ASCVD risk. APOs significantly predicted the future development of MCMs in the low baseline risk model (P< 0.01), interacting significantly with BMI slope (P=0.01). There were no significant predictors of new MCMs in the high-risk model. Poverty index was not significant in the high or low risk group (P=0.19 vs P=0.42).

Conclusion:

Without an APO, low ASCVD risk women are more likely to develop MCMs that contribute to lifetime ASCVD if they gain and retain pregnancy weight. Interventions targeting postpartum ASCVD risk reduction should include both those with APOs and excessive weight gain in/ between pregnancies to decrease the lifelong burden of women’s cardiovascular morbidity and mortality.