Prevention & lipids

Prepregnancy Adiposity, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk in Midlife

J Am Coll CardiolPublished Secondary analysis of the HAPO FUS prospective cohort study

Authors' conclusion

In this multinational cohort of pregnant individuals, APOs mediated a small proportion of the association between prepregnancy obesity and CVD risk in mid-life.

Study context

Population
Pregnant participants aged ≥18 years without prepregnancy hypertension or diabetes, HAPO FUS, followed up 11.6 ± 1.3 years after delivery10.6% prepregnancy obesity
Participants
4,269 participants
Comparison
Prepregnancy obesity vs normal prepregnancy body mass index (BMI)
Primary endpoint
Proportion of the association between prepregnancy BMI and midlife cardiovascular disease (CVD) risk factors (MAP, triglycerides, HbA1c) mediated by GDM and new-onset HDP
Follow-up
11.6 ± 1.3 years after delivery
Methodological detailsmultinational, mediation analysis
  • Multinational
  • Mediation analysis

Primary result

As reported in the abstract

Midlife CVD risk factors, obesity vs normal BMI, and mediation by APOs · follow-up at mean age 41.7 ± 5.6 years
Obesity vs Normal BMIDifference, mm Hg (95% CI)
MAP
7.0(6.0–8.1)
Obesity vs Normal BMIDifference, mg/dL (95% CI)
Triglycerides
28.5(21.9–35.1)
Obesity vs Normal BMIDifference (95% CI)
HbA1c
0.3%(0.2%–0.4%)
Proportion of obesity–HbA1c association mediated by GDM (partial)
24.6% (95% CI: 20.9%-28.4%)
Proportion of obesity–MAP association mediated by new-onset hypertensive disorders of pregnancy (HDP) (partial)
12.4% (95% CI: 10.6%-14.2%)

Further findings

Incidence of adverse pregnancy outcomes (APOs)

GDM
13.8%
New-onset HDP
10.7%

Original publication

Prepregnancy Adiposity, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk in Midlife. J Am Coll Cardiol. Published 22 April 2025. doi:10.1016/j.jacc.2025.02.033

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