Cardiovascular physiology in early pregnancy, as evaluated with N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, appears to be an important determinant of both pregnancy outcomes and future cardiovascular disease, including hypertension, according to study results published in JAMA Cardiology.

The cohort study used data from the prospective, multicenter Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health study. The investigators sought to explore whether higher levels of NT-proBNP in early pregnancy would be associated with hypertensive disorders of pregnancy (HDP), as well as with future cardiovascular risk 2 and 7 years postpartum. They compared NT-proBNP concentrations in low-risk nulliparous women in early pregnancy according to the following parameters: whether the pregnancies were uncomplicated, or whether they developed HDP or other adverse pregnancy outcomes (APOs) and whether the women did or did not develop chronic hypertension at study follow-up. The main study outcomes were HDP and incident hypertension—defined as a systolic blood pressure of 130 mm Hg or greater, a diastolic blood pressure of 80 mm Hg or greater, or the use of antihypertensive agents—at the follow-up visit.

A total of 4103 nulliparous women with complete data available and no prepregnancy hypertension or diabetes, who were treated at 8 clinical sites, were included in the study. All of the women were followed up for 2 to 7 years after their pregnancy. All data were obtained from October 2010 through October 2017 and were analyzed from August 2020 through November 2021. The mean participant age was 27.0±5.6 years.


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Among these women, 22.2% experienced an APO and 19.9% had hypertension at the follow-up visit. Higher NT-proBNP levels were associated with a lower risk for hypertensive disorders (adjusted odds ratio [OR] per doubling, 0.81; 95% CI, 0.73-0.91), which persisted even after adjusting for age, self-reported race or ethnicity, early pregnancy BMI, aspirin use, and smoking status. Higher NT-proBNP concentrations in early pregnancy were also linked to a lower risk for incident hypertension 2 to 7 years following delivery (adjusted OR per doubling, 0.84; 95% CI, 0.77-0.93), with this association continuing after controlling for confounders, such as HDP.

“Overall, findings from this cohort study support the importance of early-pregnancy cardiovascular adaptation not only for healthy pregnancy outcomes but also as a marker of future cardiovascular health,” the researchers wrote.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference  

Hauspurg A, Marsh DJ, McNeil RB, et al. Association of N-terminal pro-brain natriuretic peptide concentration in early pregnancy with development of hypertensive disorders of pregnancy and future hypertension. JAMA Cardiol. Published online January 19, 2022. doi:10.1001/jamacardio.2021.5617