Ms Erin Ashley, Dr Megan Gow, Lauren Moore, Yamema Esber, Gregory K Davis, Lynne M Roberts2,4, Prof Anthony J O'Sullivan4, A/Prof Amanda Henry1,2,3
1Discipline of Women’s Health, School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia, 2Department of Women’s and Children's Health, St George Hospital, Kogarah, Australia, 3The George Institute for Global Health, UNSW Medicine and Healt, Sydney, Australia, 4St George and Sutherland Clinical Campus, School of Clinical Medicine, UNSW Medicine and Healt, Kogarah, Australia
Biography:
Biographies to come.
Abstract:
Background. Hypertensive disorders of pregnancy (HDP) complicate 5-10% of pregnancies worldwide and are associated with significantly elevated long term cardiometabolic disease risks. Despite this, the trajectory of maternal metabolic health throughout the early postpartum period following hypertensive pregnancy is poorly characterised. This study aimed to compare body composition, metabolic parameters and energy balance in women throughout the first 5-years following hypertensive and normotensive pregnancy to investigate the persistence and/or development of metabolic dysfunction post-HDP.
Methods. This longitudinal sub-study of the Postpartum Physiology, Psychology and Paediatric (P4) study assessed maternal metabolic outcomes at 5-years following normotensive (165), preeclamptic (44) and gestational hypertensive (GH) (14) pregnancy and compared this to existing 6-month and 2-year data. Metabolic assessment consisted of serum biochemistry, anthropometry and bioimpedance analysis to indicate body composition. Energy intake was assessed via 3-day food diary, and energy expenditure using the SenseWear Armband worn for 24-hours.
Results. The preeclampsia and GH cohorts had significantly higher insulin (median 8.2 and 9.0 vs. 5.8μIU/mL, p=0.009 and p=0.02) and HOMA-IR scores (median 1.7 and 1.8 vs. 1.3 units, p=0.03 and p=0.02) than the normotensive cohort at 5-years postpartum. Following GH, women also had higher median weight (median 82.6 vs. 65.2kg, p<0.001), BMI (median 29.2 vs. 23.9kg/m2, p=0.003) and percent fat mass (43.4±7.0% vs. 34.1±9.3%, p<0.001) compared to their normotensive counterparts and had more adverse biochemical profiles. Insulin increased and cholesterol and LDL decreased between 6-months and 5-years postpartum in normotensive and preeclamptic cohorts.
Conclusion. At 5-years postpartum, women after HDP had significantly more adverse metabolic profiles compared to women following normotensive pregnancy and this was particularly marked following GH. As these risk factors are modifiable, the development and effective implementation of lifestyle-focused interventions and risk-monitoring programs are of likely utility in reducing post-HDP cardiometabolic risk.
Keywords
hypertensive disorders of pregnancy, preeclampsia, cardiometabolic risk
References
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