(1087) Weight gained or never lost: the relationship between pregnancy weight trajectory and lifelong cardiometabolic risk

This single-site retrospective cohort study followed the BMI trajectories of individuals with first singleton births occurring from 2014-2015, no subsequent multiple gestations, and recent intra-institutional follow-up. Linear models were fitted to the BMI course of each participant, both within a pregnancy and from their initial weight at first pregnancy to last recorded weight. APOs and CCs that developed after the qualifying pregnancy, and demographics, were abstracted; CC development was modeled with respect to BMI trajectories, initial pregnancy BMIs, APO occurrence, and age.

Results:

A total of 525 patients (998 pregnancies) were analyzed (Table 1). Mean initial BMI was 29.1kg/m²±7.1 for qualifying pregnancies and 29.41kg/m²±6.8 for additional pregnancies. Initial BMI was highly correlated with APO occurrence (P < 0.01) and the development of multiple CCs was associated with higher initial BMI (Figure 1). Having an APO or an initial BMI≥30.1kg/m² range in any pregnancy was associated with earlier age-adjusted CC development (P < 0.01, Figure 1). CC development was significantly predicted by increasing initial BMI (P=0.04) and age (P=0.03), but not intra-pregnancy weight slope (P=0.19) or total follow-up weight slope (P=0.80).

Conclusion:
Initial pregnancy weight, as opposed to BMI trajectory within a pregnancy or in longitudinal follow-up, predicted the development of CCs such as diabetes and cardiovascular disease. Adverse pregnancy outcomes, though closely related to BMI, independently predict these events. Optimizing prepregnancy BMI and preventing post-gestational weight retention should be a priority in preventing CCs in women.