Adverse Pregnancy Outcomes and Predicted 30-Year Risk of Maternal Cardiovascular Disease 2-7 Years After Delivery

OBJECTIVE

To determine whether adverse pregnancy outcomes are associated with a higher predicted 30-year risk of atherosclerotic cardiovascular disease (CVD; ie, coronary artery disease or stroke).

METHODS

This was a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. The exposures were adverse pregnancy outcomes during the first pregnancy (ie, gestational diabetes mellitus [GDM], hypertensive disorder of pregnancy, preterm birth, and small- and large-for-gestational-age [SGA, LGA] birth weight) modeled individually and secondarily as the cumulative number of adverse pregnancy outcomes (ie, none, one, two or more). The outcome was the 30-year risk of atherosclerotic CVD predicted with the Framingham Risk Score assessed at 2-7 years after delivery. Risk was measured both continuously in increments of 1% and categorically, with high predicted risk defined as a predicted risk of atherosclerotic CVD of 10% or more. Linear regression and modified Poisson models were adjusted for baseline covariates.

RESULTS

Among 4,273 individuals who were assessed at a median of 3.1 years after delivery (interquartile range 2.5-3.7), the median predicted 30-year atherosclerotic CVD risk was 2.2% (interquartile range 1.4-3.4), and 1.8% had high predicted risk. Individuals with GDM (least mean square 5.93 vs 4.19, adjusted β=1.45, 95% CI, 1.14-1.75), hypertensive disorder of pregnancy (4.95 vs 4.22, adjusted β=0.49, 95% CI, 0.31-0.68), and preterm birth (4.81 vs 4.27, adjusted β=0.47, 95% CI, 0.24-0.70) were more likely to have a higher absolute risk of atherosclerotic CVD. Similarly, individuals with GDM (8.7% vs 1.4%, adjusted risk ratio [RR] 2.02, 95% CI, 1.14-3.59), hypertensive disorder of pregnancy (4.4% vs 1.4%, adjusted RR 1.91, 95% CI, 1.17-3.13), and preterm birth (5.0% vs 1.5%, adjusted RR 2.26, 95% CI, 1.30-3.93) were more likely to have a high predicted risk of atherosclerotic CVD. A greater number of adverse pregnancy outcomes within the first birth was associated with progressively greater risks, including per 1% atherosclerotic CVD risk (one adverse pregnancy outcome: 4.86 vs 4.09, adjusted β=0.59, 95% CI, 0.43-0.75; two or more adverse pregnancy outcomes: 5.51 vs 4.09, adjusted β=1.16, 95% CI, 0.82-1.50), and a high predicted risk of atherosclerotic CVD (one adverse pregnancy outcome: 3.8% vs 1.0%, adjusted RR 2.33, 95% CI, 1.40-3.88; two or more adverse pregnancy outcomes: 8.7 vs 1.0%, RR 3.43, 95% CI, 1.74-6.74). Small and large for gestational age were not consistently associated with a higher atherosclerotic CVD risk.

CONCLUSION

Individuals who experienced adverse pregnancy outcomes in their first birth were more likely to have a higher predicted 30-year risk of CVD measured at 2-7 years after delivery. The magnitude of risk was higher with a greater number of adverse pregnancy outcomes experienced.

Study Design and Protocol of the Multisite Pregnancy 24/7 Cohort Study

Hypertensive disorders of pregnancy and other adverse pregnancy outcomes (APOs) are associated with an increased risk of future maternal cardiovascular disease. Physical activity during pregnancy reduces the risk of these APOs, yet few meet physical activity guidelines during pregnancy. Little is known about the role of sedentary behavior or sleep in APOs, a critical gap in knowledge given these behaviors comprise the majority of a 24-hour day. To address this knowledge gap, the Pregnancy 24/7 cohort study (2020-2025) uses 2 devices for 24-hour activity assessment in each trimester of pregnancy to examine associations of sedentary behavior, sleep, and the 24-hour activity cycle (composition of sedentary behavior, physical activity, and sleep) with hypertensive disorders and other APOs. Participants (n = 500) are recruited from the University of Iowa, University of Pittsburgh, and West Virginia University in early pregnancy and followed through delivery. The activPAL3 micro and Actiwatch Spectrum Plus are worn in each trimester for 7 days of 24-hour wear to assess the 24-hour activity cycle. APOs are abstracted from medical charts. This study will provide critical data to fuel future research examining how modifying the 24-hour activity cycle in pregnancy can improve maternal health.

Hypertensive disorders of pregnancy and midlife maternal cognition in a prospective cohort study

Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disorders, with recent evidence linking pre-eclampsia with vascular dementia. We examined associations of HDP with cognitive performance measured in midlife, in a prospective cohort study, the Avon Longitudinal Study of Parents and Children. Six cognitive function domains were measured 20 years after pregnancy at a mean age of 51 years. The cognition tests were repeated at clinics in the following two years. Cognitive function domains measured were immediate and delayed verbal episodic memory, working memory, processing speed, verbal intelligence, and verbal fluency. Exposures were pre-eclampsia, gestational hypertension (GH), and a combined category of any HDP, all compared to normotensive pregnancy. Of 3393 pregnancies included in the analysis, GH was experienced by 417 (12.3%) and pre-eclampsia by 57 (1.7%). GH was associated with lower verbal episodic memory, in the delayed logic memory test (-0.16 SDs; 95% CI -0.30, -0.03; p = .015) and there was weak evidence of an association with the immediate logic memory test (-0.13 SDs; -0.27, 0.001; p = .058). However, we did not see steeper declines by age for women with GH and there was no evidence of associations with other cognitive domains or for pre-eclampsia with any domains. Results were not substantially changed after controlling for midlife blood pressure. Our findings suggest that a history of GH is associated with slightly reduced episodic memory 20 years after pregnancy, but we found no evidence of a quicker age-related decline compared to women with normotensive pregnancies.

Blood Pressure Trajectories Through the First Year Postpartum in Overweight or Obese Individuals Following a Hypertensive Disorder of Pregnancy

BACKGROUND

Hypertensive disorders of pregnancy are associated with cardiovascular disease; however, patterns of blood pressure (BP) recovery are understudied. We compared pregnancy and postpartum BP trajectories among individuals with hypertensive disorders of pregnancy who developed persistent hypertension at 1-year postpartum compared with individuals with normalization of BP.

METHODS

We used data from a randomized clinical trial of individuals with overweight, obesity, and hypertensive disorders of pregnancy conducted in the first year after delivery. Pregnancy BPs were obtained during prenatal visits; postpartum BPs were prospectively obtained through home monitoring. Demographic characteristics and trajectories were compared by hypertensive status (systolic BP ≥130 mm Hg, diastolic BP ≥80 mm Hg, or use of antihypertensive medications) at 1 year. We used repeated BP measures to fit separate mixed-effects linear regression models for pregnancy and postpartum using restricted cubic splines.

RESULTS

We included 129 individuals; 75 (58%) individuals progressed to hypertension by 1-year postpartum. Individuals with hypertension were older, delivered at earlier gestational ages, and had higher body mass index at 1-year postpartum compared with those with normalization. Individuals with hypertension had similar BP trajectories during pregnancy to those with BP normalization but a significantly different BP trajectory (P<0.01 for systolic and diastolic BPs) in the first year postpartum. These differences persisted in multivariable models after adjustment for early pregnancy body mass index, age, and severity of hypertensive disorder of pregnancy (P<0.01 for systolic and diastolic BPs).

CONCLUSIONS

BP trajectories in the first year postpartum, but not during pregnancy, may provide important information for risk stratification after a hypertensive disorder of pregnancy.

REGISTRATION

URL: https://clinicaltrials.gov; Unique identifier: NCT03749746.

Diet Quality, Sedentary Time, and Blood Pressure in the POUCHmoms Study

BACKGROUND

Elevated blood pressure (BP) is a major contributor to cardiovascular disease in womens; diet and sedentary time (ST) are modifiable lifestyle factors thought to influence BP.

OBJECTIVES

The aim of this study was to examine 2 diet-quality measures and ST in relation to BP among parous womens.

METHODS

This cross-sectional analysis uses data from 677 womens (age 25-55 y) enrolled in the Pregnancy Outcomes and Community Health (POUCH) Study and followed up in the POUCHmoms study 7-15 y after delivery (2011 and 2014). Follow-up measures included a food-frequency questionnaire (FFQ), self-report of ST (occupational and leisure), and systolic and diastolic blood pressure (SBP and DBP, respectively). The FFQ was used to calculate 2 diet-quality measures, Alternative Healthy Eating Index-2010 (AHEI) and Dietary Approaches to Stop Hypertension (DASH). Total ST h/wk was dichotomized at the median and labeled "low" or "high." In weighted unadjusted and adjusted regression models, BP was assessed in relation to diet scores (linear and threshold associations) and combinations of dichotomized diet-quality scores ("poor" = lowest quartile compared with "not poor" = upper 3 quartiles) and ST.

RESULTS

Higher mean SBP and DBP occurred mainly in women with a '"poor" diet-quality score (AHEI and DASH). Among womens with a "poor"-quality diet (on the basis of the AHEI score) and "high" ST, (N = 93) adjusted mean SBP and DBP were 4.5 mmHg and 4.4 mmHg higher, respectively, than that of the counterparts who did not have a poor-quality diet and had "low" ST (N = 275). Results were similar in analyses using the DASH diet score.

CONCLUSIONS

Women with poor-quality diets and more ST may need closer BP monitoring. Even modest improvements in womens' diet quality and reductions in ST might help lower their BP, but this observation needs testing in prospective studies..

Adverse pregnancy outcomes and renal-vascular function in the early years after delivery

Adverse pregnancy outcomes (APOs: hypertensive disorders, gestational diabetes, preterm birth, and placental disorders) are associated with cardiovascular disease risk or blood volume abnormalities. Traditional risk factors might not identify highest risk people in the early years after APO deliveries. Test the hypothesis that vascular function is worse, and plasma volume-regulating renal hormones are lower after delivery in people who did versus did not have an APO. Adult participants 6 mo-3 years postdelivery of a singleton infant participated in this cross-sectional study. Exclusion criteria included current smoking, current use of certain medications, and diabetes outside of pregnancy. Differences in measurements between participants with versus without APOs were determined with t tests or Wilcoxon tests. Associations of renal hormones with APO history were assessed with linear regression, adjusted for age, race, body mass index (BMI), and sodium consumption. Of 86 participants, 38 (44%) had an APO history. Those with APOs were more likely to identify as Black and had a higher BMI, 34.0 kg/m2 [interquartile range (IQR), 24.6, 39.3] versus 24.2 kg/m2 [IQR, 21.2, 31.3], P < 0.05. Most brachial and all aortic blood pressures were higher in those with APOs: median aortic blood pressure was 102/74 versus 96/68 mmHg, P ≤ 0.05. There were no differences in arterial stiffness or endothelial function between groups. Aldosterone was lower (54 [IQR, 28-84] vs. 80 [IQR, 39-150] pmol/L) in participants with past APOs. Blood pressures were higher, and aldosterone was lower in participants with past APOs. Associations of aldosterone with APO history persisted after adjustment. Neither renin nor aldosterone were related to vascular function.NEW & NOTEWORTHY Adverse pregnancy outcomes (APOs) are associated with cardiovascular disease (CVD) risk. Traditional CVD risk factors may not fully capture excess CVD risk soon after APOs. Vascular dysfunction and plasma volume irregularities may be detectable. We found people with APOs had worse blood pressures, higher BMI, and lower aldosterone levels versus those without APOs in the early years after delivery. Vascular function was similar between groups. Future research should assess vascular function and renal hormones at multiple timepoints during the perinatal period.

Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk

BACKGROUND

Obesity is a well-established risk factor for both adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD). However, it is not known whether APOs are mediators or markers of the obesity-CVD relationship. This study examined the association between body mass index, APOs, and postpartum CVD risk factors.

METHODS

The sample included adults from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be) Heart Health Study who were enrolled in their first trimester (6 weeks-13 weeks 6 days gestation) from 8 United States sites. Participants had a follow-up visit at 3.7 years postpartum. APOs, which included hypertensive disorders of pregnancy, preterm birth, small-for-gestational-age birth, and gestational diabetes, were centrally adjudicated. Mediation analyses estimated the association between early pregnancy body mass index and postpartum CVD risk factors (hypertension, hyperlipidemia, and diabetes) and the proportion mediated by each APO adjusted for demographics and baseline health behaviors, psychosocial stressors, and CVD risk factor levels.

RESULTS

Among 4216 participants enrolled, mean±SD maternal age was 27±6 years. Early pregnancy prevalence of overweight was 25%, and obesity was 22%. Hypertensive disorders of pregnancy occurred in 15%, preterm birth in 8%, small-for-gestational-age birth in 11%, and gestational diabetes in 4%. Early pregnancy obesity, compared with normal body mass index, was associated with significantly higher incidence of postpartum hypertension (adjusted odds ratio, 1.14 [95% CI, 1.10-1.18]), hyperlipidemia (1.11 [95% CI, 1.08-1.14]), and diabetes (1.03 [95% CI, 1.01-1.04]) even after adjustment for baseline CVD risk factor levels. APOs were associated with higher incidence of postpartum hypertension (1.97 [95% CI, 1.61-2.40]) and hyperlipidemia (1.31 [95% CI, 1.03-1.67]). Hypertensive disorders of pregnancy mediated a small proportion of the association between obesity and incident hypertension (13% [11%-15%]) and did not mediate associations with incident hyperlipidemia or diabetes. There was no significant mediation by preterm birth or small-for-gestational-age birth.

CONCLUSIONS

There was heterogeneity across APO subtypes in their association with postpartum CVD risk factors and mediation of the association between early pregnancy obesity and postpartum CVD risk factors. However, only a small or nonsignificant proportion of the association between obesity and CVD risk factors was mediated by any of the APOs, suggesting APOs are a marker of prepregnancy CVD risk and not a predominant cause of postpartum CVD risk.

Immune Markers, Blood Pressure Severity, and Cardiac Remodeling 1 to 2 Years After Hypertensive Disorders of Pregnancy

Background Cardiovascular dysfunction and hypertension can persist postpartum following hypertensive disorders of pregnancy (HDPs). This study hypothesized that activin A, proinflammatory markers and concentric remodeling by echo would be higher 1-2 years postpartum following HDP with persistent hypertension compared to HDP with normalized blood pressure (BP). We further hypothesized correlations between biomarkers with BP and echocardiographic indices. Methods and Results This study enrolled participants with HDPs but no prepregnancy hypertension followed 1 to 2 years after delivery. Activin A and inflammatory cytokines, BP, and echocardiograms were obtained. Biomarker concentrations and echocardiographic parameters were compared between HDP with and without persistent hypertension. Individuals with persistent hypertension at a mean of 1.6 years postpartum had significantly higher activin A concentrations (median[interquartile range 25-75] 230.6 [196.0-260.9] versus 175.3 pg/mL [164.3-188.4]; P<0.01), more concentric left ventricular concentric remodeling (relative wall thickness >0.42, 48% versus 7%; P<0.01), and worse peak left atrial strain (33.4% versus 39.3%; P<0.05) as compared with those whose BP normalized. Higher activin A and interleukin-6 concentrations correlated with higher systolic (activin A: r=0.43, P=0.01) and diastolic BP (activin A: r=0.58, P<0.01; interleukin-6: r=0.36; P<0.05), as well as greater left ventricular thickness (activin A and interventricular septal thickness: r=0.41, interleukin-6 and interventricular septal thickness: r=0.36; both P<0.05). Conclusions Individuals with HDPs and persistent hypertension had significantly higher activin A and greater concentric remodeling compared with those with HDPs and normalized BP at 1 to 2 years postpartum. Activin A was positively correlated with both BP and echocardiographic indices (left ventricular thickness), suggesting overlapping processes between persistent hypertension and cardiac remodeling.

Associations of Physical Activity and Lactation Duration With Cardiometabolic Risk Factors: The CARDIA Study

BACKGROUND

Physical activity (PA) and lactation benefit cardiometabolic health.

OBJECTIVES

The purpose of this study was to describe the joint associations of PA and lactation with cardiometabolic risk.

METHODS

We averaged PA across exams and summed lifetime lactation in Black and White parous women in the Coronary Artery Risk Development in Young Adults Study. Categories were created for PA (-PA:

RESULTS

The median PA was 256 exercise units and 54% reported lactation duration of ≥3 months. Of 1,068 participants, 303 were in the -PA/-L category, 231 in -PA/+L, 184 in +PA/-L, and 350 in +PA/+L. +PA/+L participants were older, had more years of education, lower body mass index, gained less weight, and less likely to be Black vs -PA/-L participants. Risk scores differed between categories except -PA/+L and +PA/-L (P = 0.08): -PA/-L: 0.23+/-0.04, -PA/+L: 0.08+/-0.04, +PA/-L: -0.02+/-0.05, and +PA/+L: -0.23+/-0.03. After adjustment, +PA/+L was associated with a lower/better risk score (β = -0.15, 95% CI: -0.25 to -0.04).

CONCLUSIONS

Above average PA throughout adulthood combined with ≥3 months of lactation was associated with lower risk scores. Participants with either behavior had lower risk vs those with neither behavior. Attaining these levels of behaviors may reduce cardiometabolic risk in parous women.

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Key Words

• cardiometabolic risk
• lactation
• physical activity

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MESH Headings Collapse

Grants

• R01 DK090047 NIDDK NIH HHS
• HHSN268201800004I NHLBI NIH HHS
• R01 HL149796 NHLBI NIH HHS
• R01 DK106201 NIDDK NIH HHS
• HHSN268201800007I NHLBI NIH HHS
• HHSN268201800005I NHLBI NIH HHS
• HHSN268201800006I NHLBI NIH HHS
• K01 DK059944 NIDDK NIH HHS
• HHSN268201800003I NHLBI NIH HHS

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Affiliation(s)

Abbi Lane Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
Kara M. Whitaker Department of Health and Human Physiology, Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
Muna Tahir ICON plc, San Francisco, California, USA
Bethany Barone Gibbs Department of Epidemiology and Biostatistics, School of Public Health, University of West Virginia, Morgantown, West Virginia, USA
Janet Catov Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Obstetrics and Gynecology, Magee-Women’s Research Center, Pittsburgh, Pennsylvania, USA
Mercedes Carnethon Department of Preventive Medicine, Feinberg School of Medicine, Chicago, Illinois, USA
Erica P. Gunderson Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA

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Postpartum home blood pressure monitoring and lifestyle intervention in overweight and obese individuals the first year after gestational hypertension or pre-eclampsia: A pilot feasibility trial

OBJECTIVE

To test the feasibility of a randomised trial of home blood pressure monitoring paired with a remote lifestyle intervention (Heart Health 4 New Moms) versus home blood pressure monitoring alone versus control in individuals with a hypertensive disorder of pregnancy in the first year postpartum.

DESIGN

Single-blinded three-arm randomised clinical trial.

SETTING

Two tertiary care hospitals and a community organisation.

POPULATION

Postpartum overweight and obese individuals with a hypertensive disorder of pregnancy and without pre-pregnancy hypertension or diabetes.

METHODS

We assessed the feasibility of recruitment and retention of 150 participants to study completion at 1-year postpartum with randomisation 1:1:1 into each arm. Secondary aims were to test effects of the interventions on weight, blood pressure and self-efficacy.

RESULTS

Over 23 months, we enrolled 148 of 400 eligible, screened individuals (37%); 28% black or other race and mean pre-pregnancy body mass index (BMI) of 33.4 ± 6.7 kg/m2 . In total, 129 (87%) participants completed the 1-year postpartum study visit. Overall, 22% of participants developed stage 2 hypertension (≥140/90 mmHg or on anti-hypertensive medications) by 1 year postpartum. There were no differences in weight or self-efficacy across the study arms.

CONCLUSION

In this pilot, randomised trial, we demonstrate feasibility of HBPM paired with a lifestyle intervention in the first year postpartum. We detected high rates of ongoing hypertension, emphasising the need for the development of effective interventions in this population.

Factors associated with self-report of polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults study (CARDIA)

BACKGROUND

Polycystic ovary syndrome (PCOS) is underdiagnosed, but factors associated with women's report of diagnosis are not well-understood, particularly social determinants of health. Therefore, in a population-based cohort, we compared the characteristics of women with self-reported PCOS vs. women who have unrecognized PCOS vs. women without PCOS.

METHODS

We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a population-based, prospective cohort of Black and White women. Participants were women (n = 2028) who responded to the question, "Did a doctor or nurse ever tell you that you had polycystic ovarian syndrome or polycystic ovarian disease?" at the year 15 examination. Women who answered "yes" were defined as having self-reported PCOS. Women who answered "no or not sure" were defined as having unrecognized PCOS if they also had irregular menses and hyperandrogenemia between 20 and 30 years of age. Exposures of interest included social determinants of health, symptoms including irregular menses and hirsutism, and comorbid conditions.

RESULTS

Forty-three (2.1%) of women had self-reported PCOS, 135 (6.7%) had unrecognized PCOS, and 1850 (91%) women were without PCOS. In logistic regression models adjusting for age, race, and center, women with self-reported PCOS were more likely to have obesity (OR 1.83, 95% CI 1.22, 2.75) and diabetes (OR 2.37, 95% CI 1.05, 5.33) compared to women without PCOS. Women with unrecognized PCOS were more likely to have hypertension (OR 1.68, 95% CI 1.03, 2.74) and food insecurity (OR 1.94, 95% CI 1.25, 3.01) compared to women without PCOS.

CONCLUSIONS

Unrecognized PCOS is common. Self-report of PCOS is not associated with access to healthcare. Women who report PCOS are more often obese and comorbidities may contribute to recognition of PCOS.

Can allostatic load in pregnancy explain the association between race and subsequent cardiovascular disease risk: A cohort study

OBJECTIVE

To assess the relationship between allostatic load, a measure of cumulative chronic stress in early pregnancy and cardiovascular disease risk, 2-7 years postpartum, and pathways contributing to racial disparities in cardiovascular disease risk.

DESIGN

Secondary analysis of a prospective cohort study.

SETTING MULTICENTER POPULATION

Pregnant women.

METHODS

Our primary exposure was high allostatic load in the first trimester, defined as at least 4 of 12 biomarkers (systolic blood pressure, diastolic blood pressure, body mass index, cholesterol, low-density lipoprotein, high-density lipoprotein, high-sensitivity C-reactive protein, triglycerides, insulin, glucose, creatinine and albumin) in the unfavourable quartile. Logistic regression was used to test the association between high allostatic load and main outcome adjusted for confounders: time from index pregnancy and follow up, age, education, smoking, gravidity, bleeding in the first trimester, index adverse pregnancy outcomes, and health insurance. Each main outcome component and allostatic load were analysed secondarily. Mediation and moderation analyses assessed the role of high allostatic load in racial disparities of cardiovascular disease risk.

MAIN OUTCOME MEASURE

Incident cardiovascular disease risk: hypertension, or metabolic disorders.

RESULTS

Cardiovascular disease risk was identified in 1462/4022 individuals (hypertension: 36.6%, metabolic disorder: 15.4%). After adjustment, allostatic load was associated with cardiovascular disease risk (adjusted odds ratio [aOR] 2.0, 95% CI 1.8-2.3), hypertension (aOR 2.1, 95% CI 1.8-2.4) and metabolic disorder (aOR 1.7, 95% CI 1.5-2.1). Allostatic load was a partial mediator between race and cardiovascular disease risk. Race did not significantly moderate this relationship.

CONCLUSIONS

High allostatic load during pregnancy is associated with cardiovascular disease risk. The relationships between stress, subsequent cardiovascular risk and race warrant further study.

Women's Reproductive Milestones and Cardiovascular Disease Risk: A Review of Reports and Opportunities From the CARDIA Study

In 1985 to 1986, the CARDIA (Coronary Artery Risk Development in Young Adults) study enrolled 5115 Black or White participants, including 2788 women, aged 18 to 30 years. Over the following 35 years, the CARDIA study amassed extensive longitudinal data on women's reproductive milestones, spanning menarche to menopause. Although not initially conceived as a study of women's health, >75 CARDIA study publications address relationships between reproductive factors and events with cardiovascular and metabolic risk factors, subclinical and clinical cardiovascular disease, and social determinants of health. The CARDIA study was one of the earliest population-based reports to note Black-White differences in age at menarche and associations with cardiovascular risk factors. Adverse pregnancy outcomes, particularly gestational diabetes and preterm birth, have been assessed along with postpartum behaviors, such as lactation. Existing studies have examined risk factors for adverse pregnancy outcomes and lactation, as well as their relationship to future cardiovascular and metabolic risk factors, diagnoses, and subclinical atherosclerosis. Ancillary studies examining components of polycystic ovary syndrome and ovarian biomarkers, such as anti-Müllerian hormone, have facilitated examination of reproductive health in a population-based cohort of young adult women. As the cohort transitioned through menopause, examination of the importance of premenopausal cardiovascular risk factors along with menopause has improved our understanding of shared mechanisms. The cohort is now aged in the 50s to mid-60s, and women will begin to experience a greater number of cardiovascular events as well as other conditions, such as cognitive impairment. Thus, in the next decade, the CARDIA study will provide a unique resource for understanding how the women's reproductive life course epidemiology informs cardiovascular risk, as well as reproductive and chronological aging.

Feasibility of Utilizing Telehealth in a Multidisciplinary Postpartum Hypertension Clinic

Introduction

Remote delivery of care improves outcomes following hypertensive disorders of pregnancy, but little is known about the implementation of a multidisciplinary clinic in the virtual space. In this study, we developed a multidisciplinary postpartum hypertension clinic with a telehealth component run jointly with Maternal-Fetal Medicine and Cardiology.

Materials and Methods

Women were referred from Cardiology and Obstetrics providers or through our postpartum remote blood pressure (BP) program and were offered the option of an in-person or telemedicine visit. For virtual visits, BP was recorded by home measurement. We compared clinical and demographic characteristics by visit type (virtual vs. in-person).

Results

Of 175 patients scheduled (2019-2021), 140 attended visits (80% show rate) a mean of 11 weeks postpartum, with 92 (65.7%) seen virtually and 48 (34.2%) seen in-person. Clinical and demographic factors, including self-reported race and insurance type, did not differ between women seen virtually versus in-person. Overall, 97 (69.3%) of women were still on antihypertensive agents at the time of their visit with 33 (34.0%) on more than one antihypertensive agent, which did not differ by visit type. Women who were seen virtually lived a farther distance from the clinic (median 11.6 [interquartile range; IQR 7.7, 30.8] vs. median 7.9 [IQR 5.8, 21.1] miles; p = 0.02).

Conclusions

Implementation of a multidisciplinary postpartum hypertension clinic in the virtual space is feasible, targets women at high risk for persistently elevated postpartum BP, and maintains equal attendance compared with in-person visits. Virtual visits deliver care equitably across different racial and socioeconomic groups and may improve access to care in rural areas.

PSUN175 Impact of Maternal Low Weight on Pregnancy and Neonatal Outcomes

Underweight body mass index (BMI) is defined as a BMI &lt;18.5 kg/m2 and a subset of low-weight women also meet DSM-5 criteria for a diagnosis of anorexia nervosa. Although anorexia nervosa is often associated with functional hypothalamic amenorrhea and resultant infertility, when women with anorexia nervosa do conceive, there is an increased risk of obstetrical and delivery complications, and poor neonatal outcomes, such as preterm birth, low birth weight, and smaller size for gestational age (SGA). Few studies have investigated such outcomes in women who are low weight, with or without a diagnosis of anorexia nervosa. The aim of the study was toexamine associations between underweight maternal BMI and pregnancy complications and neonatal outcomes in mothers and infants at a large academic medical center. There was a total of 16,780 mothers who delivered a singleton between 2015-2021 with either a BMI &lt;18.5 kg/m2 (n=732) or who were normal-weight (18.5 kg/m2 &lt; BMI &lt;25 kg/m2, n=16,048) at their initial prenatal visit or within six months of that visit. We compared neonatal outcomes and pregnancy/delivery complications in the low-weight versus normal-weight mother-infant pairs. Neonatal outcomes included birthweight, gestational age, NICU stay, preterm birth, and fetal death; pregnancy and delivery complications included pre-eclampsia/eclampsia, premature rupture of membranes (PROM), and post-partum hemorrhage. Median BMI in underweight women was 17.8 [interquartile range: 17.2, 18.1] kg/m2 compared with 22.2 [20.7, 23.6] kg/m2 in normal-weight women. Underweight women were younger (27 [22, 31] years) and less likely to be married or have private insurance (p-value &lt;0.0001 for all). Approximately 22% of the low-weight mothers were African American compared with 13.4% of normal-weight mothers (overall p-value for race/ethnicity &lt;0.0001). Additionally, approximately 22% of infants born to low-weight mothers were SGA and 15% with low birthweight compared with 13.6% and 9% of infants born to normal-weight mothers, respectively (p-value &lt;0.0001 for both SGA and low birthweight). These differences remained significant after adjusting for maternal age, race/ethnicity, marital and insurance status, and maternal depression; after adjusting for these potential confounders, infants born to low-weight mothers had increased risk for SGA (OR=1.23, 95% CI: 1.11-1.36) and low birthweight (OR=1.18, 95% CI: 1.04-1.33) compared with their normal-weight counterparts. In adjusted models, underweight women had decreased risk of PROM (OR=0.85, 95% CI: 0.74-0.98) and post-partum hemorrhage (OR=0.72, 95% CI: 0.54-0.96) compared to normal-weight women. No differences were noted for pre-eclampsia/eclampsia, NICU stay, preterm birth, and fetal death. In summary, underweight BMI during pregnancy is associated with an increased risk of infants who are SGA and low birthweight and a decreased risk for delivery complications including PROM and post-partum hemorrhage. These differences suggest underweight BMI during pregnancy increases the risk for adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Association between aspirin use during pregnancy and cardiovascular risk factors 2-7 years after delivery: The nuMoM2b Heart Health Study

OBJECTIVES

To evaluate the association between aspirin use during first pregnancy and later maternal cardiovascular risk.

STUDY DESIGN

In this secondary analysis of a prospective cohort, we included participants who carried their first pregnancy to 20 + weeks, had data regarding aspirin use, and attended a study visit 2-7 years following delivery. The exposure was aspirin use during the first pregnancy. We calculated aspirin use propensity scores from logistic regression models including baseline variables associated with aspirin use in pregnancy and cardiovascular risk. Outcomes of interest were incident cardiovascular-related diagnoses 2-7 years following delivery. Robust Poisson regression calculated the risk of outcomes by aspirin exposure, adjusting for the aspirin use propensity score.

MAIN OUTCOME MEASURES

The primary outcome was a composite of incident cardiovascular diagnoses at the time of the study visit: cardiovascular events, chronic hypertension, metabolic syndrome, prediabetes or type 2 diabetes, dyslipidemia, and chronic kidney disease.

RESULTS

Of 4,480 women included, 84 (1.9%) reported taking aspirin during their first pregnancy. 52.6% of participants in the aspirin-exposed group and 43.0% in the unexposed group had the primary outcome. After adjusting for the aspirin use propensity scores, aspirin use during the first pregnancy was not associated with any of the outcomes.

CONCLUSION

We did not detect an association between aspirin use during the first pregnancy and cardiovascular-related diagnoses 2-7 years later. Our study was only powered to detect a large difference in relative risk, so we cannot rule out a smaller difference that may be clinically meaningful.

Excessive Gestational Weight Gain and Long-Term Maternal Cardiovascular Risk Profile: The Study of Women's Health Across the Nation

Background: Excessive gestational weight gain (GWG) is consistently linked with maternal risk of obesity. However, the literature on its long-term cardiovascular risk is minimal and conflicting. We evaluated whether excessive GWG is associated with a high-risk cardiovascular profile among parous women in midlife. Materials and Methods: Participants were women in the multiethnic cohort Study of Women's Health Across the Nation with a history of live birth(s). Excessive GWG was defined according to Institute of Medicine guidelines and collected by self-recall. Outcomes were the atherosclerotic cardiovascular disease (ASCVD) risk score and C-reactive protein (CRP), measured at the study baseline when mean age was 47 years, and at 10 follow-up visits (1996-2017). We estimated the association of excessive GWG with outcomes through linear mixed model regression. Results: The analytic sample included 1318 women with 3049 singleton births. Over 40% (536) reported one or more pregnancies with excessive GWG. Longitudinal models estimated that at a mean age of 67, women with a history of excessive GWG had a 9.8% (9.2, 10.5) 10-year ASCVD risk, compared to 9.5% (8.9, 10.1) for those without, and mean CRP of 2.20 mg/L (1.89, 2.57) versus 1.85 mg/L (1.61, 2.14), respectively, adjusted for participant characteristics. Conclusions: In this multiethnic cohort of parous women, a history of excessive GWG was associated with a small, but statistically significant difference in ASCVD risk, and a moderate, statistically significant difference in CRP across midlife. More research is necessary to understand the mechanistic pathway between excessive GWG and long-term maternal cardiovascular health.

Treatment of Gestational Diabetes Mellitus and Offspring Early Childhood Growth

BACKGROUND

Gestational diabetes mellitus (GDM) is associated with fetal overgrowth, and certain treatments are associated with an increased risk of macrosomia. However, there are limited data about the long-term effect of GDM treatment on childhood growth.

METHODS

Cohort study of 816 women with GDM and their offspring delivered between 2009 and 2012. Childhood height and weight through age 3 were collected from the medical record and z-scores and body mass index (BMI) were calculated. We assessed the association between GDM treatment and childhood growth using linear mixed modeling.

RESULTS

Treatment was divided into medical nutritional therapy (MNT) (n = 293), glyburide (n = 421), and insulin (n = 102). At delivery, birthweight, z-score, and BMI were higher in the offspring of women treated with either glyburide or insulin compared to MNT. However, weight, z-score, and BMI were similar among all offspring at 6 months and 1, 2, and 3 years of age. After controlling for covariates, there were differences in the weight z-score (P = 0.01) over the 3-year period by treatment group, but no differences in weight (P = 0.06) or change in BMI (P = 0.28). Pairwise comparisons indicated that insulin was associated with more weight gain compared with MNT (0.69 kg; 95% CI, 0.10-1.28; P = 0.02) and glyburide was associated with a trend toward lower weight z-score compared with MNT (-0.24; 95% CI, -0.47 to 0.003; P = 0.05).

CONCLUSION

Despite growth differences detected at birth, we observed no meaningful differences in childhood growth from 6 months to 3 years among treatment groups, including in the offspring of women with GDM treated with glyburide.

Associations of Sleep With Sedentary Behavior and Physical Activity Patterns Across Pregnancy Trimesters

INTRODUCTION

Sleep, sedentary behavior, and moderate-to-vigorous physical activity (MVPA) are altered in pregnancy and may affect pregnancy health; however, how these behaviors are associated with each other is unclear.

METHODS

Pregnant women (N = 120) completed the Pittsburgh Sleep Quality Index and wore an activPAL3 micro and ActiGraph GT3X for 7 days in each trimester to assess sleep, sedentary behavior, and MVPA, respectively. Latent trajectories described patterns of sleep duration, efficiency, and quality as well as sedentary behavior and MVPA. Multinomial logistic regression examined associations of sleep patterns with sedentary behavior and MVPA patterns and, in exploratory analyses, with adverse pregnancy outcomes.

RESULTS

Trajectories were identified for sleep duration (consistently short, 20.7% of sample; consistently adequate, 79.3%), efficiency (consistently low, 17.5%; consistently high, 82.5%), and quality (consistently poor, 15.1%; worsening, 23.5%; and consistently good, 61.5%). Compared with those in more optimal sleep groups, women in the short duration, low efficiency, and worsening quality groups had lower odds of being in the moderate and/or high sedentary behavior group (odds ratio range, 0.21-0.31; 95% confidence interval range, 0.09-0.65). Women in the worsening quality group had greater odds of being in the low MVPA group (odds ratio, 2.51; 95% confidence interval, 1.18-5.38). Trends were observed with women in less optimal sleep groups having greater odds of adverse pregnancy outcomes and lower odds of excessive gestational weight gain.

CONCLUSIONS

Less optimal sleep patterns in pregnancy are associated with less sedentary behavior and MVPA; additional research is needed to confirm associations between sleep and pregnancy outcomes.

Go Red for Women Strategically Focused Research Network: Summary of Findings and Network Outcomes

The Go Red for Women movement was initiated by the American Heart Association (AHA) in the early 2000s to raise awareness concerning cardiovascular disease (CVD) risk in women. In 2016, the AHA funded 5 research centers across the United States to advance our knowledge of the risks and presentation of CVD that are specific to women. This report highlights the findings of the centers, showing how insufficient sleep, sedentariness, and pregnancy-related complications may increase CVD risk in women, as well as presentation and factors associated with myocardial infarction with nonobstructive coronary arteries and heart failure with preserved ejection fraction in women. These projects were augmented by collaborative ancillary studies assessing the relationships between various lifestyle behaviors, including nightly fasting duration, mindfulness, and behavioral and anthropometric risk factors and CVD risk, as well as metabolomic profiling of heart failure with preserved ejection fraction in women. The Go Red for Women Strategically Focused Research Network enhanced the evidence base related to heart disease in women, promoting awareness of the female-specific factors that influence CVD.

Decidual Vasculopathy Identification in Whole Slide Images Using Multiresolution Hierarchical Convolutional Neural Networks

After a child is born, the examination of the placenta by a pathologist for abnormalities, such as infection or maternal vascular malperfusion, can provide important information about the immediate and long-term health of the infant. Detection of the pathologic placental blood vessel lesion decidual vasculopathy (DV) has been shown to predict adverse pregnancy outcomes, such as preeclampsia, which can lead to mother and neonatal morbidity in subsequent pregnancies. However, because of the high volume of deliveries at large hospitals and limited resources, currently a large proportion of delivered placentas are discarded without inspection. Furthermore, the correct diagnosis of DV often requires the expertise of an experienced perinatal pathologist. We introduce a hierarchical machine learning approach for the automated detection and classification of DV lesions in digitized placenta slides, along with a method of coupling learned image features with patient metadata to predict the presence of DV. Ultimately, the approach will allow many more placentas to be screened in a more standardized manner, providing feedback about which cases would benefit most from more in-depth pathologic inspection. Such computer-assisted examination of human placentas will enable real-time adjustment to infant and maternal care and possible chemoprevention (eg, aspirin therapy) to prevent preeclampsia, a disease that affects 2% to 8% of pregnancies worldwide, in women identified to be at risk with future pregnancies.

Maternal Serum Lipid Trajectories and Association with Pregnancy Loss and Length of Gestation

OBJECTIVE

We characterized lipid trajectories and investigated lipids and rate of pregnancy lipid change with the risk of pregnancy loss or preterm delivery <37 weeks.

STUDY DESIGN

In a secondary analysis of 337 women with one to two prior losses assigned to placebo in a randomized controlled trial at four centers (2007-2012), cholesterol, low- and high-density lipoprotein cholesterol (HDL-C), and triglycerides were measured up to 6 months prepregnancy (time 0) and pregnancy up to 7 visits. Trajectories were created using linear mixed models. Multivariable logistic regression with adjustment for maternal characteristics and cholesterol was performed.

RESULTS

Lipids decreased from prepregnancy to 4 to 5 weeks, followed by an increase, and were biphasic or triphasic depending on the lipid component. Between 4 and 8 weeks, for every 1-unit increase in HDL-C, there was a 22% decreased odds of loss <14 weeks (odds ratio: 0.78; 95% confidence interval: 0.60, 0.99) and 24% decreased odds of loss or preterm delivery 14 to <37 weeks (odds ratio: 0.76; 95% confidence interval: 0.60, 0.96).

CONCLUSION

There were no associations with other lipid components or other time points. An impaired rise of HDL-C early in pregnancy may signal maladaptation to pregnancy that is associated with pregnancy loss or preterm delivery.

Perinatal Outcomes Associated with Early Diabetes Testing in Pregnancies Complicated by Obesity

OBJECTIVE

This study aimed to determine whether early diabetes testing is associated with differences in perinatal outcomes among pregnant women with obesity (body mass index ≥30 kg/m²).

STUDY DESIGN

We conducted a retrospective cohort study of singleton pregnancies from 2012 to 2014 at a large academic medical center which examined the association of diabetes testing (HBA1c, 50 g glucose challenge test, or 100 g oral glucose tolerance test) before 24 weeks with perinatal outcomes using propensity score modeling and logistic regression.

RESULTS

Among women with obesity, 790 out of 2,698 (29.3%) underwent early diabetes testing. Propensity score modeling demonstrated that early testing was associated with higher rates of diabetes diagnosis (odds ratio [OR]: 1.62, 95% confidence interval [CI]: 1.10-2.37, p = 0.01) and a trend toward small for gestational age birth weight (OR: 1.38, 95% CI: 1.00-1.90, p = 0.05) and neonatal composite morbidity (OR: 1.25, 95% CI: 1.00-1.57, p = 0.05) compared with routine testing. Women with inadequate weight gain were more likely a small for gestational age (SGA) infant if they underwent early testing compared with those with routine testing alone (19.8 vs. 11.6%, p = 0.01).

CONCLUSION

Early testing targets higher risk women and yields a higher diabetes diagnosis rate, but inadequate weight gain in these women may increase risk SGA birth weight and neonatal morbidity. Randomized clinical trials are urgently needed to assess whether early diabetes testing improves outcomes in women with obesity.

Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum

Background

Identifying pregnancy‐associated risk factors before the development of major cardiovascular disease events could provide opportunities for prevention. The objective of this study was to determine the association between outcomes in first pregnancies and subsequent cardiovascular health.

Methods and Results

The Nulliparous Pregnancy Outcomes Study Monitoring Mothers‐to‐be Heart Health Study is a prospective observational cohort that followed 4484 women 2 to 7 years (mean 3.2 years) after their first pregnancy. Adverse pregnancy outcomes (defined as hypertensive disorders of pregnancy, small‐for‐gestational‐age birth, preterm birth, and stillbirth) were identified prospectively in 1017 of the women (22.7%) during this pregnancy. The primary outcome was incident hypertension (HTN). Women without adverse pregnancy outcomes served as controls. Risk ratios (RR) and 95% CIs were adjusted for age, smoking, body mass index, insurance type, and race/ethnicity at enrollment during pregnancy. The overall incidence of HTN was 5.4% (95% CI 4.7% to 6.1%). Women with adverse pregnancy outcomes had higher adjusted risk of HTN at follow‐up compared with controls (RR 2.4, 95% CI 1.8‐3.1). The association held for individual adverse pregnancy outcomes: any hypertensive disorders of pregnancy (RR 2.7, 95% CI 2.0‐3.6), preeclampsia (RR 2.8, 95% CI 2.0‐4.0), and preterm birth (RR 2.7, 95% CI 1.9‐3.8). Women who had an indicated preterm birth and hypertensive disorders of pregnancy had the highest risk of HTN (RR 4.3, 95% CI 2.7‐6.7).

Conclusions

Several pregnancy complications in the first pregnancy are associated with development of HTN 2 to 7 years later. Preventive care for women should include a detailed pregnancy history to aid in counseling about HTN risk.

Clinical Trial Registration

URL: http://www.clinicaltrials.gov Unique identifier: NCT02231398.

Antibiotic Use in Pregnancy, Abnormal Fetal Growth, and Development of Gestational Diabetes Mellitus

OBJECTIVE

Antibiotics are commonly used in pregnancy. Prior studies have indicated that antibiotic use in pregnancy may affect birth weight, whereas data in nonpregnant individuals suggest that antibiotic exposure may increase diabetes risk. We evaluated the impact of antibiotic prescriptions during pregnancy on the prevalence of small for gestational age (SGA) and large for gestational age (LGA) birth weight and gestational diabetes mellitus (GDM).

STUDY DESIGN

This retrospective cohort study of 12,551 women who delivered at a large academic medical center between 2012 and 2014 assessed the number and type of antibiotic prescriptions prior to GDM testing using the electronic medical record. SGA and LGA birth weight and GDM rates were compared among women who were or were not prescribed antibiotics.

RESULTS

Overall, 3,991 (31.8%) of 12,551 patients received at least one antibiotic prescription. After covariate adjustment, no differences existed in risk of SGA (adjusted odds ratio [aOR]: 1; 95% confidence interval [CI]: 0.88-1.15; p = 0.94), LGA (aOR: 1; 95% CI: 0.86-1.17; p = 0.97), or GDM (aOR: 0.90; 95% CI: 0.72-1.13; p = 0.36) between women who were or were not prescribed antibiotics.

CONCLUSION

Antibiotic use does not affect the risk of SGA or LGA birth weight or GDM in pregnant women. These results provide reassurance regarding the use of antibiotics when clinically indicated in pregnancy.

Pre-pregnancy kidney function and subsequent adverse pregnancy outcomes

BACKGROUND

Renal insufficiency is associated with pregnancy complications including fetal growth restriction, preterm birth (PTB), and pre-eclampsia.

OBJECTIVE

To determine the effect of preconception kidney function within the normal range on pregnancy outcome.

METHOD

1043 (50% black, 50% white) women who participated in the CARDIA study who had kidney function and biochemical analyses measured before at least one pregnancy delivered during the 20 years post-baseline period were included in analysis. Kidney function estimated as glomerular filtration rate (eGFR) via modified CKD-EPI equations, serum creatinine, and urinary albumin/creatinine ratio were evaluated as predictors of infant birthweight, gestational age, birthweight-for-gestational-age, and hypertensive disorders of pregnancy via self-report, using multiple regression with adjustment for confounders (age, race, smoking, BMI, center, parity, systolic blood pressure at baseline). Serum uric acid was also examined at both baseline and year 10.

RESULTS

Unadjusted pre-pregnancy eGFR (baseline) was associated with lower average birthweight-for-gestational-age, but this disappeared after adjustment for confounders. A decline in GFR from baseline to year 10 was associated with lower birthweight (adjusted estimate -195 g, p = 0.03 overall), especially among whites. After adjustment for confounders, no association was found with gestational age or hypertensive disorders.

CONCLUSIONS

No strong evidence for an association between preconception kidney function in the normal range and birthweight or gestational age was found. Possible racial differences in these relationships warrant further examination.

Pregnancy as a Window to Racial Disparities in Hypertension

BACKGROUND

The black-white disparity in hypertension (HTN) among U.S. women persists after accounting for known risk factors. Pregnancy complications may reveal increased risks for later HTN. We examined the contribution of HTN risk factors measured at both midlife and pregnancy to black-white disparities in midlife HTN.

METHODS

Data came from a Michigan-based longitudinal study beginning in pregnancy. At 7-15 years postpregnancy (n = 615, mean age = 37), women were assessed for cardiovascular health, including blood pressure, and categorized as hypertensive (n = 126), prehypertensive (n = 149), and normotensive (n = 340). Midlife risk factors for HTN were assessed in four domains: socioeconomic status (SES), psychosocial, behavioral, and physiological. We used generalized logit models to assess the degree to which each domain attenuated the black (vs. white) odds ratio (OR) for HTN at midlife. We then added indicators of pregnancy health, that is, preterm delivery, prepregnancy body mass index (BMI), C-reactive protein (CRP) levels, depressive symptoms, smoking, hypertensive disorders, and lipid levels.

RESULTS

Black women had 3.3 (95% CI: 2.0-5.5) times the odds of HTN compared to white women after adjusting for age. Following adjustment for midlife SES, and psychosocial, behavioral, and physiological factors, the OR was 2.1 (95% CI: 1.2-4.0). Adjustment for prepregnancy BMI, CRP, and depressive symptoms during pregnancy reduced the OR to 1.9 (95% CI: 1.0-3.7).

CONCLUSIONS

Known risk factors measured at midlife explained some, but not all, of the race disparity in midlife HTN. Indicators of pregnancy health also contributed to the race disparity in HTN at midlife.

Invited Commentary: Gestational Hypertension and Diabetes-A Major Public Health Concern

The obesity epidemic in the United States and other countries has contributed to an increase in the rates of gestational diabetes and hypertension. In the past, it was thought that most cases of gestational diabetes and hypertension would resolve after completion of pregnancy. In this issue of the Journal, Pace et al. (Am J Epidemiol. 2017;186(10):1115-1124) clearly documented that both gestational diabetes and hypertension lead to diabetes and hypertension and that the combination of both during pregnancy leads to very high rates of subsequent diabetes and hypertension. A new generation of epidemiology studies using the evolving new technologies and genetics (host susceptibility studies) are needed to improve our understanding of the etiology of gestational diabetes and hypertension. Early identification of women at risk of gestational diabetes and hypertension, better treatment during pregnancy, and preventive and clinical therapies for treatment of diabetes and hypertension after pregnancy are very important for improving women's health and reducing risk of cardiovascular disease later in life.

Mother's pre-pregnancy BMI is an important determinant of adverse cardiometabolic risk in childhood

OBJECTIVE

Maternal adiposity is associated with poor offspring cardiometabolic health. We aimed to evaluate the relationship of maternal pre-pregnancy body mass index (BMI) on the BMI, body composition and cardiometabolic characteristics of the offspring.

METHODS

Forty offspring of overweight/obese mothers (O-OW) and 28 offspring of normal weight mothers (O-NW) underwent evaluation of body composition, abdominal fat distribution, blood pressure measurement, fasting lipids and an oral glucose tolerance test. The anthropometric and cardiometabolic characteristics of O-OW were compared with those of O-NW, and the relationship to maternal BMI was evaluated.

RESULTS

Subjects (mean age: 12.6 ± 0.4, female: 52.9%) had similar gestational age, birth weight, age, gender, and Tanner stage. However, O-OW had a significantly higher BMI (24.4 ± 1.2 vs. 19.7 ± 0.8 kg/m(2) , p = 0.001), % body fat (31.7 ± 1.6 vs. 24.6 ± 1.1%, p < 0.001), visceral fat (41.9 ± 4.7 vs. 26.1 ± 3.9 cm(2) , p = 0.012) with no difference in lean body mass compared with O-NW. O-OW had lower whole body insulin sensitivity index (WBISI) with an adverse cardiovascular disease risk profile [higher blood pressure (BP), triglycerides to high-density lipoprotein (HDL) ratio, hs-C-reactive protein (CRP) and lower HDL]. In addition to offspring's %body fat (β = -0.60, p < 0.001), maternal pre-pregnancy BMI (β = -0.19, p = 0.046) contributed significantly and independently to the offspring's WBISI (R(2) =0.55, p < 0.001).

CONCLUSIONS

High pre-pregnancy BMI is an important contributor to excess adiposity, insulin resistance, and cardiometabolic disease risk in the offspring during childhood.

Abstract LB-273: Prognosis and conditional disease-free survival among ovarian cancer patients

Background: Survival estimates are traditionally reported from the time of diagnosis or remission. Although these estimates provide important information, they are not necessarily still applicable to patients who have already survived a period of time after their initial diagnosis and treatment. Conditional disease-free survival accounts for elapsed time since achieving remission and may offer more relevant prognostic information to patients and their clinicians. More accurate information about risk of recurrence will not only allow patients and clinicians to make better informed decisions regarding follow-up care after cancer treatment but may also improve quality of life by ameliorating patients’ fear of recurrence. This study aimed to estimate conditional disease-free survival among ovarian cancer patients and to identify factors that impact disease-free survival. To our knowledge, no prior studies have assessed conditional disease-free survival among ovarian cancer patients. Patients and Methods: We used data collected as part of the Hormones and Ovarian Cancer Prediction (HOPE) case-control study; in total, 404 cases, all of whom had achieved remission after a diagnosis of ovarian cancer, were included in the current analyses. The majority of patients were Caucasian, median age at diagnosis was 58.6 years, and 5.5% had a family history of ovarian-only or breast and ovarian cancer. Demographic and lifestyle information was collected at enrollment; disease and clinical characteristics, including follow-up data, were abstracted from medical records. Disease-free survival was calculated using the Kaplan-Meier method. Conditional disease-free survival estimates were computed using cumulative disease-free survival estimates. Results: Median disease-free survival was 2.54 years (range: 0.03-9.96 years) and 3-year disease-free survival was 48.2%. The probability of surviving an additional 3 years without recurrence, conditioned on having already survived 1, 2, 3, 4, and 5 years after remission, was 63.8%, 80.5%, 90.4%, 97.0% and 97.7%, respectively. Initial differences in disease-free survival at time of remission between age, stage, histology and grade groups diminished over time. Conclusion: Disease-free survival estimates for ovarian cancer patients improved dramatically over time, in particular among those with poorer initial prognoses. Our results demonstrate that conditional disease-free survival is a more relevant measure of prognosis for ovarian cancer patients who have already achieved a period of remission and that time elapsed since remission should be taken into account when making follow-up care decisions.

Citation Format: Michelle Kurta, Robert Edwards, Kirsten Moysich, Kathleen McDonough, Marnie Bertolet, Joel Weissfeld, Janet Catov, Francesmary Modugno, Clareann Bunker, Roberta Ness, Brenda Diergaarde. Prognosis and conditional disease-free survival among ovarian cancer patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-273. doi:10.1158/1538-7445.AM2014-LB-273