Perinatal & Pediatric
Adolescent Cardiovascular Risk Trajectories and Later Life Maternal Morbidity Annabelle Ng* Annabelle Ng Natalie Boychuk Teresa Janevic Katharine McCarthy
Nearly one-third of U.S. pregnancy-related deaths are attributable to poor cardiovascular health (CVH). Less is known about how CVH risk progresses from adolescence to young adulthood to influence pregnancy health in later life. We estimated the relative risk of gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) among individuals in midlife by their cardiovascular risk in adolescence and young adulthood. Data were drawn from the National Longitudinal Study of Adolescent and Adult Health, where waves I-II corresponded to ages 11-19 years (adolescence), wave III ages 18-26 (young adulthood), and wave V ages 33-43. The final sample was 1,095 birthing individuals who completed all follow-up assessments and did not have pre-pregnancy diabetes. CVH risk was assessed using an adapted Life’s Essential 8 scale, categorized into low, medium and high risk. Ever experiencing a pregnancy complication was self-reported in wave V. Risk of GDM and HDP was estimated using log binomial regression adjusting for maternal and sociodemographic characteristics. We found that those with high vs. low CVH risk in adolescence had 2.4 times (95% CI: 1.4, 4.2) the risk of future GDM. No association was observed among those with moderate vs. low CVH risk (adjusted risk ratio (aRR) 1.2, 95% CI: 0.70, 2.0). We found a small increased risk of HDP among those with high (aRR 1.2, 95% CI: 0.8, 1.7) or moderate adolescent CVH risk (aRR 1.2, 95% CI: 0.9, 1.6) vs. low risk but confidence intervals were inclusive of the null. The highest incidence of GDM was observed among those who maintained high risk status between adolescence and young adulthood (34.9%), relative to those who stayed low (8.3%) or moderate risk (12.1%) over time, or who were high risk and reduced their risk to low (16.7%) or moderate (17.8%). Findings support the potential of prevention efforts targeting CVH risk trajectories in adolescence to offset maternal morbidity later in the lifecourse.