The Association between Pregnancy Complications and Long-Term Maternal Cardiometabolic Health in the MIREC Cohort Study

Context: During pregnancy, women who experience certain pregnancy complications show elevations in biomarkers of inflammation and insulin resistance; however, few studies have examined these cardiometabolic biomarkers in the decade following pregnancy.

Objective: To examine the association between pregnancy complications and cardiometabolic biomarkers 9 years postpartum including: blood pressure, blood lipids, body fat percentage, insulin resistance (glucose, insulin, proinsulin, C-peptide, HOMA-IR, HbA1c, leptin, adiponectin) and inflammation (hs-C-reactive protein).

Methods: Using data from the Maternal-Infant Research on Environmental Chemicals (MIREC) cohort study (2008-2021) we determined 3 groups of pregnancy complications: 1) hypertensive disorders of pregnancy (HDP) (n=35); any pregnancy complication in the index pregnancy, defined as preterm birth, HDP, impaired glucose tolerance or gestational diabetes mellitus (GDM) (n=55); or self-reported recurrence of one of these pregnancy complications (n=19). Our comparison group included 186 women with uncomplicated pregnancies.

Results: In our adjusted linear regression results, all pregnancy complication groups showed significantly higher systolic and diastolic blood pressure 9 years later. HOMA-IR was 23% (95% CI: -4.4%, 57%), 26% (95% CI: 2.0%, 55%), and 51% (95% CI: 12%, 104%) higher at follow-up in participants who had experienced a prior HDP, an index pregnancy complication, or a recurrent pregnancy complication respectively. Elevations were also seen with HbA1c, insulin, C-peptide, and leptin especially among those with recurrent complications.

Conclusion: This study contributes to the body of evidence that women with a history of certain pregnancy complications merit special attention in the prevention of CVD. We recommend further exploration into these associations in larger cohorts.