Table 4.
Association of Early Pregnancy CVD Risk Factors With Hypertension* 2 to 7 Years After Delivery Among nuMoM2b‐Heart Health Study Participants †
| Early Pregnancy CVD Risk Factors | Model A ‡ , RR (95% CI) | Model B ‡ , RR (95% CI) | Model C ‡ , § , RR (95% CI) |
|---|---|---|---|
| BMI, per kg/m2 | 1.05 (1.05–1.06) | 1.03 (1.02–1.04) | 1.03 (1.02–1.04) |
| Total cholesterol, per 0.3 mmol/L | 1.03 (1.01–1.04) | 1.01 (1.00–1.03) | 1.01 (1.00–1.03) |
| HDL‐C, per 0.1 mmol/L | 0.96 (0.94–0.98) | 0.99 (0.97–1.01) | 0.99 (0.97–1.01) |
| LDL‐C, per 0.3 mmol/L | 1.02 (1.01–1.03) | 1.01 (1.00–1.02) | 1.01 (1.00–1.02) |
| Glucose, per 0.6 mmol/L | 1.08 (1.05–1.11) | 1.03 (1.00–1.06)^ | 1.02 (0.98–1.06) |
| Insulin, per doubling in value ‖ | 1.15 (1.11–1.19) | 1.04 (0.99–1.08) | 1.02 (0.98–1.07) |
| hs‐CRP, per doubling in value ‖ | 1.20 (1.15–1.25) | 1.06 (1.02–1.11) | 1.07 (1.02–1.12) |
| Triglycerides, per doubling in value ‖ | 1.55 (1.39–1.71) | 1.27 (1.14–1.41) | 1.27 (1.13–1.42) |
| Systolic blood pressure, per 5 mm Hg | 1.20 (1.18–1.23) | 1.08 (1.05–1.11) | 1.08 (1.04–1.12) |
| Diastolic blood pressure, per 5 mm Hg | 1.29 (1.26–1.33) | 1.17 (1.13–1.21) | 1.16 (1.11–1.21) |
| Diet quality score, per 1 unit | 0.98 (0.96–0.99) | 1.00 (0.98–1.01) | 1.00 (0.98–1.01) |
| Physical activity, per 3 h per week of moderate or vigorous activity | 0.88 (0.81–0.95) | 0.93 (0.87–0.99) | 0.93 (0.87–0.99) |
| ASCVD risk score, per 1% increase in estimated risk ¶ | 1.00 (0.98–1.02) | … | … |
| ≥5% estimated risk ¶ | 0.93 (0.50–1.73) | … | … |
| Latent profile estimated class (vs class 1) | |||
| Class 2: mostly obese with higher insulin, hs‐CRP, and BP | 2.45 (2.11–2.85) | 1.13 (0.88–1.44) | 1.09 (0.83–1.44) |
| Class 3: largely nonobese with higher cholesterols | 1.29 (1.06–1.55) | 1.14 (0.94–1.37) | 1.10 (0.90–1.35) |
| Class 4: total and LDL‐C in the top decile | 1.98 (1.60–2.44) | 1.31 (1.04–1.64) | 1.28 (1.00–1.63) |
ASCVD indicates atherosclerotic cardiovascular disease; BMI, body mass index; BP, blood pressure; CVD, cardiovascular disease; HDL‐C, high‐density lipoprotein cholesterol; hs‐CRP, high‐sensitivity C‐reactive protein; LDL‐C, low‐density lipoprotein cholesterol; and RR, relative risk.
Hypertension 2 to 7 years after index pregnancy is defined as ≥ 130 mm Hg systolic blood pressure or ≥80 mm Hg diastolic blood pressure, or self‐report of antihypertensive medication use.
When the CI shown includes 1.00 because of rounding, the ^ symbol indicates that the precise CI excludes 1 (ie, is statistically significant at P<0.05).
Model A is adjusted for the following covariates: baseline age, race, insurance, and smoking. Models B and C are adjusted for the following covariates: baseline age, race, insurance, smoking, BMI, systolic blood pressure, and diastolic blood pressure. Models B and C do not adjust for BMI, systolic blood pressure, or diastolic blood pressure when they are the risk factor of interest.
Model C restricts to nuMoM2b‐Heart Health Study participants without chronic hypertension or pregestational diabetes mellitus. Chronic hypertension is defined as diagnosis of hypertension before index pregnancy or hypertension present (systolic ≥140 mm Hg or diastolic ≥90 mm Hg on two occasions at least 6 hours apart or on one occasion followed by antihypertensive medication therapy) before 20° weeks gestation per nuMoM2b chart abstraction. Pregestational diabetes mellitus is defined as diagnosis of diabetes mellitus before index pregnancy per nuMoM2b chart abstraction.
This characteristic is included in statistical models after a log2 (logarithm with base 2) transformation. RRs for log‐transformed quantities are interpreted on the multiplicative scale.
The models with ASCVD risk score are not adjusted for the covariates of age, race, smoking, and insurance, because the first three of these covariates are included in the calculation of the risk score.