Hypertensive disorders of pregnancy linked to LV remodelling

An association exists between hypertensive disorders of pregnancy (HDP) and adverse left ventricular (LV) remodelling, which is partially mediated by post-pregnancy BMI, suggests a study.

A total of 408 and 451 women with information on HDP and gestational diabetes mellitus (GDM) from the Bogalusa Heart Study cohort were included in this analysis. Of the participants (median age at first pregnancy 22.0 years, 33.0 percent Black), 34 had HDP and 41 had GDM. The mean echocardiographic follow-up was about 15 years after pregnancy.

The researchers assessed LV mass index (LVMI), ejection fraction (LVEF), and geometry (concentric remodelling, concentric or eccentric hypertrophy) using multivariable regression, adjusted for demographic and prepregnancy cardiometabolic factors. They also assessed effect modification by age and race and mediation by post-pregnancy cardiometabolic factors.

HDP correlated with greater LVMI, but not with LVEF, in midlife (standardized β, 0.37, 95 percent confidence interval [CI], 0.01‒0.72; p=0.04) and with a higher likelihood of concentric remodelling (odds ratio, 2.48, 95 percent CI, 1.03‒6.00; p=0.04). The association between HDP and LVMI was partly mediated by post-pregnancy BMI (19.47 percent; p=0.01).

Furthermore, GDM showed no significant association with LV structure or function after adjustment. Interaction terms by age and race did not reach significance.

“These findings underscore the need for early echocardiographic monitoring and postpartum weight management in women with HDP to reduce long-term cardiovascular risk,” the researchers said.