Poor prepregnancy cardiovascular health is associated with a higher risk of developing gestational diabetes and coronary artery calcium in midlife, according to a recent Northwestern Medicine study published in JAMA Cardiology.
The findings suggest that gestational diabetes is a marker of prepregnancy cardiovascular health, underscoring the importance of healthcare providers in helping patients improve their cardiovascular health prior to pregnancy, according to Natalie Cameron, MD, ‘23 MPH, ‘21 GME, instructor in the Department of Medicine’s Division of General Internal Medicine and lead author of the study.
“We need to optimize cardiovascular health early in the life course,” said Cameron, who is also an instructor in the Department of Preventive Medicine’s Division of Epidemiology.
In the current study, the investigators analyzed patient data originally collected from 1985 to 2010 during the Coronary Artery Risk Development in Young Adults (CARDIA) study. Of the more than 1,000 participants included in the cohort, the average age was 28.6 years and 47.6 percent of participants were Black and 52.4 percent were white.
All participants had at least one singleton birth, had available prepregnancy cardiovascular health and coronary artery calcium (CAC) test data, did not have prepregnancy diabetes, and completed at least one CT scan for CAC.
Overall, the investigators found that participants with poor prepregnancy cardiovascular health compared to those with better prepregnancy cardiovascular health were more likely to have a pregnancy complicated by gestational diabetes and were more likely to develop CAC.
“Patients with gestational diabetes and other adverse pregnancy outcomes should follow up with a primary care provider so we can optimize heart health after pregnancy,” Cameron said. “We need to take a good pregnancy history, ask about lifestyle behaviors such as diet and physical activity, and screen for cardiovascular disease risk factors. Then we can work with patients to help them optimize their heart health throughout their life course.”
Cameron said her team is now interested in studying how healthcare systems can better optimize transitions of care and promote healthy lifestyle behaviors, such as physical activity, after pregnancy.
“Within the healthcare system, we are revamping our postpartum primary care referral pathway for women with adverse pregnancy outcomes to seamlessly help patients get from obstetrics to a primary care provider. From a research standpoint, we are developing an intervention that integrates FitBit data with the electronic health record to promote physical activity among postpartum women,” Cameron said.
Sadiya Khan, ’09 MD, ’14 MSc, ’10, ’12 GME, the Magerstadt Professor of Cardiovascular Epidemiology, was senior author of the study.
Co-authors of the study include Lucia Petito, PhD, assistant professor of Preventive Medicine in the Division of Biostatistics and Informatics, and Norrina Bai Allen, PhD, the Quentin D. Young Professor of Health Policy and vice chair for Research in the Department of Preventive Medicine.
This work was supported by National Heart, Lung, and Blood Institute grants 1R01HL159250 and 1U01HL160279-01, the American Heart Association Transformational Project Award (19TPA34890060), and National Institute of Diabetes and Digestive and Kidney Disease grants K01 DK059944, R01 DK090047, and R01 DK106201.
