Better Cardiovascular Health in Early Pregnancy Can Offset High Genetic Risk for Preeclampsia and Gestational Hypertension

Maintaining good cardiovascular health during the first trimester of pregnancy may significantly reduce the risk of developing preeclampsia and gestational hypertension, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2024. This finding holds true even for individuals with a high genetic risk for these hypertensive disorders of pregnancy.

Hypertensive disorders such as gestational hypertension and preeclampsia are a leading cause of mortality among expectant mothers and newborns. These conditions can be predicted using a polygenic risk score, which estimates susceptibility based on genetic profiles. Researchers aimed to determine whether cardiovascular health in early pregnancy, measured by the American Heart Association’s Life’s Essential 8 (LE8) score, could mitigate this genetic risk.

Study coauthor Vineetha Mathew, an M.D. candidate at Tufts University School of Medicine, stated, “Our results found that across all genetic risk groups, better first trimester cardiovascular health may partially mitigate the risk of adverse pregnancy outcomes and the risk of developing hypertensive disorders of pregnancy.”

The study analyzed data from over 5,000 first-time pregnant individuals to calculate the rates of hypertensive disorders. Researchers classified each individual's genetic risk using a validated polygenic risk score and assigned a cardiovascular health score based on the LE8 components: diet, physical activity, sleep, nicotine exposure, diabetes, baseline blood pressure, and body mass index. Cholesterol levels were included for a subset of participants.

The key findings of the study include:

• Favorable cardiovascular health was associated with a 35% to 62% lower risk of developing hypertensive disorders of pregnancy across all genetic risk groups.
• A higher genetic risk combined with lower cardiovascular health was linked to a higher risk of developing both preeclampsia and gestational hypertension.
• The incidence of hypertensive disorders ranged from 11% (low genetic risk, favorable cardiovascular health) to 37% (high genetic risk, unfavorable cardiovascular health).
• Higher body mass index, high blood pressure, and poor diet were significant contributors to the population-level risk for these disorders.

Donald M. Lloyd-Jones, M.D., chair of the writing group for the Association’s Presidential Advisory unveiling Life’s Essential 8, emphasized the importance of cardiovascular health throughout life, including during pregnancy. “The impressive reductions in risk for hypertensive disorders of pregnancy associated with higher cardiovascular health demonstrate that there is much within our control to help patients avoid these potentially lethal pregnancy complications,” he said.

Mathew highlighted the study's implications for medical practice: “We want to underscore the importance of preconception and early pregnancy cardiovascular health counseling. OB-GYN and primary care professionals should emphasize cardiovascular health improvement, healthier nutrition, weight management, and healthy blood pressure to patients who are considering pregnancy.”

The study's limitations include missing cholesterol metrics for about half the participants. Future research will involve expanding the study to include a more diverse population and incorporating cardiovascular health metrics throughout pregnancy and subsequent pregnancies.

The study underscores that maintaining cardiovascular health, as measured by the LE8 score, can significantly impact pregnancy outcomes and long-term cardiovascular health. This research advocates for a proactive approach to cardiovascular health, starting even before pregnancy.