A recent study conducted by Northwestern Medicine has illuminated the critical role of obesity, both before and during pregnancy, in driving the risk of future cardiovascular disease.
Prior to this groundbreaking research, the medical community grappled with uncertainty regarding which factor—obesity or pregnancy complications—played a more significant role in elevating the risk of cardiovascular disease in the years following pregnancy.
This extensive and diverse multi-center study has, for the first time, disentangled this complex question, ultimately determining that pre-pregnancy obesity serves as the primary catalyst for adverse pregnancy outcomes and the future risk of cardiovascular disease.
Remarkably, this research has followed its participants, approximately half of whom were overweight or obese, from the inception of their initial pregnancy through several years postpartum.
Dr. Sadiya Khan, the corresponding author and the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine, as well as a Northwestern Medicine physician, underscored the study’s novel findings: “We demonstrate, for the first time, that adverse pregnancy outcomes are primarily indicators—and not the root cause—of future heart health. This means that pregnancy merely unveils the risk for heart disease that is already present.”
These groundbreaking findings are slated for publication in the journal Circulation Research on October 10.
The study harnessed data from the nuMoM2b Heart Health Study, following 4,216 first-time pregnant individuals from the early stages of pregnancy to an average of 3.7 years postpartum.
At the onset of the study, the average maternal age was 27 years old, with 53% having a normal body mass index (BMI), 25% categorized as overweight, and 22% identified as having obesity.
Individuals with overweight or obese BMI during early pregnancy were found to face a heightened risk of developing hypertensive disorders of pregnancy compared to those with a normal BMI.
In this study, researchers sought to gain a deeper understanding of the interplay between maternal obesity, hypertensive disorders of pregnancy, other adverse pregnancy outcomes, and cardiovascular health in the years following childbirth.
“Our hypothesis was that it may be that the pregnancy complications are unmasking these issues, as, as we know, pregnancy serves as a natural stress test for the heart. These findings hold immense significance because, if pre-pregnancy obesity is the root cause of risk, we should be proactively addressing it with interventions. We shouldn’t wait until individuals experience cardiovascular events; we should strive to prevent them,” Dr. Khan explained.
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The study underscores the importance of interventions targeted at obesity before pregnancy—a concept emphasized in Dr. Khan’s research.
Known as the “Zero trimester,” this phase of pre-pregnancy health improvement can lead to better outcomes for both the mother and child, as well as the individual’s long-term health. However, targeting individuals before pregnancy presents challenges. Therefore, the early stages of pregnancy offer an opportune moment for healthcare professionals to counsel on heart-healthy habits such as diet and exercise, given that individuals are more likely to engage with clinicians during prenatal visits.
Dr. Khan emphasized, “We do not recommend weight loss during pregnancy but do advocate counseling and monitoring for appropriate gestational weight gain. It is one of the few times in life when you are frequently seeing a doctor while in good health.”
Studies have revealed that pregnant individuals can safely manage their weight gain throughout pregnancy by adopting healthy eating habits and engaging in moderate or even vigorous exercise.
In this study, pregnant participants were observed at eight clinical centers across the United States, including Northwestern University. The inclusion criteria were individuals aged 18 years or older with no history of pre-pregnancy hypertension or diabetes.
Approximately 15% of all participants experienced complications related to high blood pressure, 11% had low birthweight babies, 8% had preterm births, and 4% developed gestational diabetes. In the years following pregnancy, those with complications related to high blood pressure were 97% more likely to develop high blood pressure and 31% more likely to have high cholesterol.
For certain complications, the researchers discovered that body weight did not play a significant role. For instance, individuals who were overweight or had obesity did not exhibit an increased risk of having preterm births or babies with low birthweights.
Nevertheless, among all participants, those experiencing preterm births faced an elevated risk of developing high blood pressure, high blood sugar, or high cholesterol after pregnancy. The study did not find a heightened risk associated with babies born with low birthweights.
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