Better Cardiovascular Health in Early Pregnancy May Reduce Risk of Hypertensive Disorders

Maintaining good cardiovascular health during the first trimester of pregnancy may offset the genetic risk of developing preeclampsia and gestational hypertension, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2024 in Chicago. This finding is significant as hypertensive disorders of pregnancy are a leading cause of death in both expectant mothers and newborns.

The study analyzed data from over 5,000 first-time pregnant individuals and found that favorable cardiovascular health, as measured by the American Heart Association’s Life’s Essential 8 (LE8) score, was associated with a 35% to 62% lower risk of developing hypertensive disorders of pregnancy across all genetic risk groups. This suggests that good health habits can significantly reduce the risk of these dangerous conditions, even for those with a high genetic predisposition.

Researchers used a polygenic risk score to classify each participant's genetic risk and incorporated seven out of eight LE8 components—diet, physical activity, sleep, nicotine exposure, diabetes, baseline blood pressure, and body mass index—into a cardiovascular health score. Cholesterol levels were also included for a subset of participants. The study adjusted for factors like age, race, ethnicity, education level, and marital status.

Findings showed that higher body mass index, high blood pressure, and poor diet were the major contributors to the risk of developing hypertensive disorders of pregnancy. The incidence of these disorders ranged from 11% among those with low genetic risk and favorable cardiovascular health to 37% for those with high genetic risk and unfavorable cardiovascular health.

“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,” said Vineetha Mathew, a coauthor and fourth-year M.D. candidate at Tufts University School of Medicine.

The study underscores the importance of preconception and early pregnancy cardiovascular health counseling. OB-GYN and primary care professionals are encouraged to emphasize cardiovascular health improvement, healthier nutrition, weight management, and healthy blood pressure to patients who are considering pregnancy.

“What was really interesting about our findings was how cardiovascular health in the first trimester appeared to be protective for all,” Mathew added. “We saw that the odds of developing a hypertensive disorder of pregnancy among those with a high genetic risk combined with favorable cardiovascular health was comparable or even better than those with low genetic risk but unfavorable cardiovascular health.”

The research was conducted by the Broad Institute of MIT and Harvard, Massachusetts General Hospital, and Columbia University. Funded by the National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute, the study aims to expand to include more diverse populations and to incorporate cardiovascular health metrics throughout pregnancy.

Donald M. Lloyd-Jones, chair of the writing group for the Association’s Presidential Advisory unveiling Life’s Essential 8, emphasized, “These results highlight the importance of the cardiovascular health construct across the entire life course, including during pregnancy. High cardiovascular health scores, achievable through a focus on healthy lifestyle, may help mitigate the risk conferred by a person’s genes.”