BP Trajectories in Pregnancy Tied to Metabolic Syndrome Risk (CME/CE)

Action Points

• Note that this study in a largely Chinese population found that a diastolic blood pressure greater than 80 mm Hg at term was associated with postpartum metabolic syndrome.
• Be aware that diastolic pressure trajectory, i.e., the change from pre- to post-pregnancy, was also a significantly predictive risk factor.

Prehypertension among pregnant women can predict the development of postpartum metabolic syndrome, a Chinese study showed.

A single at-term measurement of diastolic blood pressure at the prehypertensive threshold of 80 mm Hg or higher was associated with an adjusted odds ratio of 2.94 for subsequent metabolic syndrome (95% CI 1.19–7.25) compared with being in the normal range below 80 mm Hg, Qiong Lei, MD, of the Guangdong Women and Children's Hospital in Guangzhou, China, and colleagues reported in Hypertension.

Women with a diastolic blood pressure trajectory putting them in the prehypertensive range for much of their pregnancy were 6.5 times more likely to develop postpartum metabolic syndrome (adjusted OR 6.55, 95% CI 1.79-23.92; P=0.04) than women who were classified as having lower or normal blood pressure while pregnant.

"Moreover, incorporating the diastolic blood pressure trajectory, but not the diastolic blood pressure prehypertension defined by a single measurement at term, with glucose and triglycerides provided a prediction model with clinically acceptable discrimination (AUC of 0.7–0.835) and good calibration," the researchers noted.

They proposed that a distinction should be made between pregnant women and the general population in blood pressure guidelines, noting the typical J- or U-shaped trajectories during pregnancy as peripheral arterial resistance changes that has left optimal pressure an "open question."

Blood pressure trajectories are relatively inexpensive, and have the potential to identify pregnant women who might be at increased risk for metabolic syndrome, according to the researchers.

"The article contributes to our expanding knowledge of the risk factors that help us identify future cardiovascular risk in women," Nieca Goldberg, MD, of the NYU Langone Joan H. Tisch Center for Women's Health in New York, said in an email to MedPage Today. "It is another way we can identify future heart disease and take risks for early steps for prevention."

Lei's group agreed that young women with risk-associated blood pressure trajectories in pregnancy may warrant early cardiovascular risk factor surveillance so that "lifestyle modifications may help delay the onset of cardiovascular disease that may present 20 to 30 years after delivery and consequently improve women's health status and quality of life."

Data was collected based on antepartum and postpartum check-ups of 307 consecutive women in Guangzhou who had a blood pressure of 140/90 mm Hg or lower, normal lipid and glucose profiles, and no tobacco or other substance abuse at 11- to 13-weeks' gestation in pregnancies that resulted in a healthy singleton live birth. Each participant underwent a minimum of seven antepartum check-ups and two postpartum check-ups at which physicians recorded body weight, measured BP, took obstetric information down, and performed an ultrasound scan.

While none of the participants had metabolic syndrome at baseline, 35 (11.3%) of them developed metabolic syndrome by their second postpartum follow-up visit.

The participants were placed in one of the three categories:

• The low-J-shaped group (32.4%), who maintained a low diastolic pressure of 62.5 to 65.0 mm Hg at 11- to 13-weeks' gestation then a J-shaped change through to term
• The moderate-U-shaped group (52.5%), who had a moderate starting diastolic pressure around 70 mm Hg at 11- to 13-weeks' gestation, followed by a slight increase, which "represents participants with blood pressure levels between normal and prehypertension levels"
• The elevated-J-shaped group (13.2%), who had an elevated starting diastolic pressure of 76.2 to 81.8 mm Hg at 11- to 13-weeks' gestation that then steeply increased over the course of the third trimester, such that they fell into the prehypertensive range for much of their pregnancy

The moderate-U-shaped group did not have significantly higher risk than those in the low-J-shaped group. Nor were systolic blood pressure or mean arterial pressure significantly associated with postpartum metabolic syndrome.

Limitations of the study included the follow-up rate of only about 60%, the solely Chinese population, lack of self-reported smoking status data, and a dearth of information about the women prior to conception.

Support for the research was provided by the Science and Technology Planning Project of Guangdong Province, and by the Tianjin Municipal Science and Technology Commission Key Funding.

The researchers disclosed no relevant relationships with industry.

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BP Trajectories in Pregnancy Tied to Metabolic Syndrome Risk (CME/CE)