Association of hypertension disorders of pregnancy and left ventricular remodeling after 15 years follow-up: findings from the Bogalusa Heart Study.

OBJECTIVES

Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are linked to later-life cardiovascular disease, but their impact on midlife cardiac health is unestablished. Therefore, we examined their associations with midlife left ventricular remodeling.

METHODS

This study included 408 and 451 women from the Bogalusa Heart Study cohort with information on HDP and GDM, respectively. Of these, 34 had HDP and 41 had GDM. Mean echocardiographic follow-up was approximately 15 years after pregnancy. Outcomes included left ventricular mass index (LVMi), ejection fraction (LVEF), and left ventricular geometry (concentric remodeling, concentric or eccentric hypertrophy). Multivariable regression was adjusted for demographic and prepregnancy cardiometabolic factors. Effect modification by age and race and mediation by postpregnancy cardiometabolic factors were evaluated.

RESULTS

Median age at first pregnancy was 22.0 years and 33.0% were Black. HDP was associated with greater LVMi in midlife (standardized β  = 0.37, 95% confidence interval [CI]: 0.01-0.72, P  = 0.04), but not with LVEF. HDP was also associated with greater odds of concentric remodeling (odds ratio = 2.48, 95% CI: 1.03-6.00, P  = 0.04). Postpregnancy BMI mediated 19.47% of the association between HDP and LVMi ( P  = 0.01). GDM was not associated with left ventricular structure or function after adjustment. Interaction terms by age and race were not significant.

CONCLUSION

HDP is associated with adverse left ventricular remodeling, partly mediated by postpregnancy BMI. These findings underscore the need for early echocardiographic monitoring and postpartum weight management in women with HDP to reduce long-term cardiovascular risk.