Background: Women with previous hypertensive disorders of pregnancy (HDP) have increased risk of cardiovascular disease (CVD). Overweight is a modifiable risk factor for both conditions. Anthropometric indices such as waist circumference, hip circumference, waist-to-hip ratio, estimated total body fat, a body shape index, waist-to-hip-to-height ratio, and index of central obesity improve estimation of cardiovascular death risk in the general population as compared to body mass index (BMI).
Objectives: We aimed to assess whether alternative body mass composition indices associate more strongly with postpartum blood lipid levels, as a proxy for CVD risk, than BMI. We also aimed to investigate whether associations differ between women with previous normotensive or hypertensive index pregnancies.
Design: In this cross-sectional study, we examined 296 women 1 or 3 years after an index pregnancy that was normotensive (n = 116) or complicated by a hypertensive pregnancy disorder, including preeclampsia (n = 133) or gestational hypertension (n = 47).
Methods: Uni- and multivariable regression analyses, adjusted for age and smoking, were conducted to evaluate associations between postpartum body mass composition indices and blood lipids. p < 0.05 was considered statistically significant.
Results: Median BMI and overweight rates were higher in women with previous HDP than in controls (23.9 kg/m2 versus 22.8 kg/m2 and 44.4% versus 30.2%, both p ⩽ 0.03). No body mass composition indices in any pregnancy complication group showed stronger associations with adverse lipid levels than BMI. However, women with previous HDP more often displayed significant associations between adverse body mass composition indices and adverse lipid levels, compared with controls.
Conclusion: Alternative anthropometric measurements are not better suited to evaluate circulating lipids as proxy for CVD risk after HDP, compared to BMI. We hence recommend using BMI in CVD risk assessment after HDP due to its current widespread use and feasibility.
Keywords: hypertension in pregnancy; obesity; obstetrics; preeclampsia; women’s health.
Cardiovascular disease risk evaluation in women after hypertensive pregnancy disorders: A study of the role of traditional and nontraditional body mass composition indicesWhy was the study done?Women who have experienced hypertensive disorders of pregnancy have increased risk of developing cardiovascular disease later in life. Overweight is a well-known risk factor for both cardiovascular disease and hypertensive disorders of pregnancy. Body mass index (BMI) is the most common used tool to evaluate overweight, but other indices to evaluate body mass composition may be better suited to evaluate cardiovascular death risk in the general population. Lipids are among several modifiable risk factors for cardiovascular disease. We therefore aimed to investigate associations between alternative body mass composition indices and risk of cardiovascular disease, using blood lipids as a marker for cardiovascular disease, in women with previous hypertensive disorders of pregnancy and women with previous uncomplicated pregnancies.What did the researchers do?We examined 296 women one or three years after pregnancy. Our study group included 180 women with previous hypertensive pregnancy disorder and 116 women with previous uncomplicated pregnancies as controls. We analyzed associations between different body mass composition indices and blood lipid levels, to evaluate the risk of cardiovascular disease after pregnancy.What did the researchers find?Women with previous hypertensive pregnancy disorders were more often overweight, compared with women with previous uncomplicated pregnancies, and showed in general higher BMIs. We found no differences between the different body mass composition indices and their associations with blood lipids. Women with previous hypertensive pregnancy disorders did however display more frequent associations between body mass composition indices and circulating lipids, compared with the control group.What do the findings mean?Following hypertensive disorders of pregnancy, women more often have elevated BMI. Their BMI is comparable to alternative body mass composition indices in association with circulating lipids. This supports using BMI in the assessment of cardiovascular disease risk in this group at high risk of cardiovascular disease development.