Slightly elevated preconception and early-pregnancy blood pressure is associated with an increased risk for recurrent pregnancy loss in young healthy women, a new study suggests.
This elevation in risk for pregnancy loss was observed in a largely normotensive cohort and adds evidence to the importance of maintaining healthy blood pressure during early adulthood, the researchers say.
“Our findings, if confirmed, suggest that addressing elevated blood pressure in young women through lifestyle change may not only have important benefits for long-term cardiovascular health, but could also have short-term benefits for risk of pregnancy loss,” lead author, Carrie Nobles, MD, from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) in Bethesda, Maryland, told the theheart.org | Medscape Cardiology.
“This study tells us that our concerns about blood pressure in young people may extend beyond the cardiovascular risks that we worry about starting at a young age to risks for getting pregnant and having babies,” American Heart Association spokesperson Mary Ann Bauman, MD, Seattle, Washington, told theheart.org | Medscape Cardiology. “That’s an important issue.”
The study was published online April 2 in Hypertension.
Nobles and colleagues say their study is the first to assess preconception blood pressure and reproductive outcomes in healthy women not diagnosed with hypertension or heart disease.
Participants were 1228 women (average age, 28.7 years; 95% white) from the Effects of Aspirin on Gestational and Reproduction (EAGeR) trial who had already experienced at least one pregnancy loss and were currently trying to become pregnant.
Average preconception systolic and diastolic blood pressures were 111.6 mm Hg and 72.5 mm Hg. Among 797 women who conceived, 188 (23.6%) suffered a pregnancy loss.
The researchers found that the risk for pregnancy loss increased 18% for every 10–mm Hg increase in diastolic blood pressure (95% confidence interval [CI], 1.03 – 1.36) and 17% per 10–mm Hg increase in mean arterial pressure (95% CI, 1.02 – 1.35), after adjustment for relevant cofactors, including age, body mass index, smoking, parity, and time since last pregnancy loss. The results were similar for early pregnancy blood pressure.
Preconception blood pressure was not related to fecundability, that is, the probability of being pregnant in a single menstrual cycle, or live birth in adjusted analyses. Whether women had been randomly assigned to take low-dose aspirin as part of the EAGeR trial made no difference in the effect of blood pressure on pregnancy loss.
Heart and Reproductive Health Linked
“The impact of cardiovascular risk factors starts really early in life,” senior author, Enrique F Schisterman, MD, chief of the epidemiology branch of NICHD, said in a news release.
“Physicians treating women of reproductive age should pay attention to slightly elevated blood pressure because it may have other not-well-recognized effects, such as adverse pregnancy outcome,” he added. “Preconception is a previously unrecognized critical window for intervention, such as lifestyle changes that can help prevent later heart disease, and may also improve reproductive health.”
The researchers say more study is needed among women with clinically defined hypertension and at risk for pregnancy loss to determine whether antihypertensive medication may be safe and effective in preventing recurrent pregnancy loss.
“This study adds to a body of information but in a unique way by looking at preconception blood pressure in women who have already had miscarriages,” Bauman told theheart.org | Medscape Cardiology. “ We don’t know if we can generalize the findings to women without a history of pregnancy loss.”
“Also, these were largely white women, highly educated and with higher socioeconomic status, so this needs to be studied in women of color and various backgrounds,” Bauman noted.
In general, she added, “We are seeing higher blood pressures in younger and younger people. I used to say that heart disease was a disease of adolescence that manifests in adulthood; now I say it’s a disease of childhood, so paying attention to blood pressure early is important,” Bauman said.
Funding for the study was provided by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors and Bauman have disclosed no relevant financial relationships.
Hypertension. Published online April 2, 2018. Abstract
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