The Association Between Pregnancy Complications and Long-term Maternal Cardiometabolic Health in the MIREC Cohort Study

Abstract

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, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), glycated hemoglobin (HbA1c), leptin, adiponectin], and inflammation (high-sensitivity-C-reactive protein). Methods Using data from the Maternal-Infant Research on Environmental Chemicals cohort study (2008-2021), we determined 3 groups of pregnancy complications: (1) hypertensive disorders of pregnancy (HDP) (n = 35); (2) any pregnancy complication in the index pregnancy, defined as preterm birth, HDP, impaired glucose tolerance or gestational diabetes mellitus (n = 55); and (3) self-reported recurrence of 1 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% confidence interval (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 cardiovascular disease. We recommend further exploration into these associations in larger cohorts.