(1271) Association between maternal vascular malperfusion and blood pressure 2-7 years postpartum

Adverse pregnancy outcomes (APO) are associated with increased cardiovascular disease (CVD). Placental pathology can reveal abnormalities that may more specifically reflect CVD risk. The purpose of this analysis was to use a large prospective multicenter study to examine the association of placental maternal vascular malperfusion (MVM) and later-life blood pressure (BP).

Study Design:

This is a secondary analysis of the numom2b Heart Health Study which entailed an in-person study visit 2-7 years after index pregnancy. Participants who had a placental pathology report in index pregnancy were included. Those with preexisting chronic hypertension in the parent study were excluded. Placental pathology reports were categorized into presence or absence of MVM by a trained perinatal pathologist based on documented lesions in the abstracted report. Mean systolic and diastolic BP (SBP, DBP) at 2-7 year visit were compared by presence/absence of MVM. Linear models, adjusted for insurance, age, BMI, and race/ethnicity were utilized to evaluate the association between MVM and BP. Secondary analysis was stratified by APO, defined as hypertensive disorder of pregnancy, stillbirth, SGA birth, preterm birth.

Results:

629 patients met inclusion criteria, of which 34.9% had MVM. The follow up visit was on average 3.0 years (IQR: 2.5, 3.6) after index pregnancy. Participants with MVM were more likely to be married and less likely to report smoking. There were no differences in age, race/ethnicity, or insurance status. In adjusted models, MVM was associated with higher SBP and DBP (SBP B 2.2 mmHg (0.3, 4.0); DBP B 2.6 mmHg (1.0, 4.2), Table). In models stratified by APO, MVM was associated with higher SBP among those without an APO (B 3.7 mmHg (1.0, 6.4)), but not among those with an APO (B 0.9 mmHg (-1.6, 3.4) Figure).

Conclusion:

MVM on placental pathology was associated with higher BP 2-7 years postpartum.  In stratified analyses, the association with SBP remained among those without an APO.   MVM may identify those at higher risk for CVD regardless of APO and should be included in future risk stratification.