First-Trimester Atherogenic Characteristics Associated With Increased Risk for Hypertension

Cropped shot of a confident female doctor checking the blood pressure of a pregnant patient at a hospital during the day
First-trimester atherogenic characteristics in women are associated with adverse pregnancy outcomes and gestational diabetes.

First-trimester atherogenic characteristics in women are associated with adverse pregnancy outcomes (APO) and gestational diabetes (GDM). These women were also at increased risk for hypertension at 2 to7 years postpartum. These findings were published in the Journal of the American Heart Association.

Between 2012 and 2015, women (N=8838) in their first trimester of their first pregnancy were recruited at 8 sites in the United States. Participants were assessed for nonfasting blood chemistry, and their pregnancy outcomes were documented in their medical records. Every 6 months, the women were contacted by telephone and asked about their health status. At 2 to7 years postdelivery, the participants (n=4471) were assessed with use of an in-person Heart Health Study visit.

Participants were aged mean 27.0 (standard deviation [SD], 5.6) years, 62.2% were White, early pregnancy body mass index (BMI) was median 24.7 (range, 15.8-64.0) kg/m2, total cholesterol was mean 4.8 (SD, 0.9) mmol/L, and low-density lipoprotein (LDL) cholesterol was 2.3 (SD, 0.7) mmol/L.

A total of 24.6% of participants had APO/GDM during their pregnancy. Women who were older than 35 years, Black, obese, smokers; women with high blood pressure and high levels of blood glucose, insulin, triglycerides, and C-reactive protein; and women with low high-density lipoprotein cholesterol levels were more likely to have APO or develop GDM (all P <.05).

Adverse pregnancy outcomes/GDM were associated with BMI (per kg/m2: relative risk [RR], 1.02; 95% CI, 1.02-1.03), glucose (per 0.6 mmol/L: RR, 1.04; 95% CI, 1.01-1.07), insulin (per doubling: RR, 1.08; 95% CI, 1.04-1.12), C-reactive protein (per doubling: RR, 1.06; 95% CI, 1.02-1.11), triglycerides (per doubling: 1.34; 95% CI, 1.21-1.48), systolic blood pressure (per 5 mm Hg: RR, 1.05; 95% CI, 1.02-1.08), diastolic blood pressure (per 5 mm Hg: RR, 1.06; 95% CI, 1.02-1.10), and atherosclerotic cardiovascular disease risk score (per 1% increase: RR, 1.02; 95% CI, 1.01-1.03).

At 2 to7 years after delivery, 32.8% of women who had APO/GDM were hypertensive compared with 18.1% who had healthy pregnancies (P <.05). Stratified by pregnancy outcome, hypertension was observed among 39.2% of the women with hypertensive disorders of pregnancy, 34.2% of the women who had preterm births, 25.9% of the women who delivered small for gestational age babies, and 35.6% of the women who had GDM.

Women who were obese, who had high insulin and C-reactive protein levels, and who had high blood pressure were associated with a total excess relative risk (eRR) for hypertension of 1.42 (95% CI, 0.96-1.87); women who were not obese and had higher cholesterol levels had an eRR of 0.32 (95% CI, 0.06-0.58); and women who were in the top decile for total and LDL cholesterol had an eRR of 0.96 (95% CI, 0.44-1.49).

This study may have been limited by not including data on subsequent births, which may have altered risk for hypertension among some women and not others.

These data indicated atherogenic characteristics associated with risk for APO/GDM. These adverse pregnancy factors increased risk for becoming hypertensive between 2 and 7 years postpartum.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Catov JM, McNeil RB, Marsh DJ, et al. Early pregnancy atherogenic profile in a first pregnancy and hypertension risk 2 to 7 years after delivery. J Am Heart Assoc. 2021;10(5):e017216. doi:10.1161/JAHA.120.017216