Blood pressure in pregnancy—A stress test for hypertension? Five‐year, prospective, follow‐up of the ROLO study

Abstract

Pregnancy is often considered a stress test for life as it may uncover conditions which reappear in later life. Many examples exist such as preeclampsia and the development of hypertension (HTN) postpartum 1 as well as antenatal insulin resistance and the development of type 2 diabetes mellitus postpartum. 2,3 Much research exists on the relationship between maternal blood glucose levels below that diagnostic for gestational diabetes mellitus (GDM) and adverse pregnancy outcomes. In 2018, O'Brien et al demonstrated that each 1 mmol/L increase in fasting blood glucose in early pregnancy leads to a 1.70 mmol/mol increase in HbA1c at 5 years postpartum. 4 Given this relationship, and the metabolic dysregulation which occurs in pregnancy, it is surprising that there is Abstract Objective: To investigate whether maternal blood pressure (BP) below the diagnostic criteria of hypertensive disorders of pregnancy (HDP) is associated with maternal BP 5 years later. Design: Prospective, observational study. Setting: Dublin, Ireland (2007-2011). Sample: Three hundred twenty-nine women from the ROLO study (Randomized cOntrol trial of LOw glycaemic index diet to prevent the recurrence of macrosomia). Methods: Maternal BP measurements were taken during pregnancy (13, 28 and 34 weeks' gestation and day 1 postpartum) and at the 5-year follow-up. Systolic BP (SBP) and diastolic BP (DBP) were categorized as normal (SBP < 120 and DBP < 80 mm Hg), elevated (SBP 120-129 and DBP < 80 mm Hg), HTN stage 1 (SBP 130-139 or DBP 80-89 mm Hg) or HTN stage 2 (SBP ≥ 140 or DBP ≥ 90 mm Hg) at each timepoint. Main Outcome Measures: Maternal blood pressure at the 5-year follow-up.Results: Women with elevated BP at 28 and 34 weeks' gestation had 2.68 (95% CI:1.36-5.26) and 2.45-fold (95% CI: 1.22-4.95) increased odds of HTN stage 1 respectively, at the 5-year follow-up, compared to those with normal BP in pregnancy. Conclusion:Elevated BP at 28 and 34 weeks' gestation was associated with an increased risk of HTN stage 1 at 5 years later. Thus, raised BP, below the diagnostic criteria of HDP, could be flagged for follow-up postpartum. K E Y W O R D Scardiovascular disease, hypertension, maternal hypertension, metabolic syndrome, pregnancy

Energy-Adjusted Dietary Inflammatory Index in pregnancy and maternal cardiometabolic health: findings from the ROLO study

“…High BP in pregnancy is associated with significant adverse outcomes for the mother, including long-term maternal CVD. 33 , 34 , 35 , 36 It has been suggested that inflammation plays a role in BP control. 37 , 38 , 39 A UK pregnancy cohort investigated the association between hypertensive disorders of pregnancy and subsequent diagnosis of 12 various CVDs.…”

Diet quality and blood pressure among pregnant women with overweight or obesity: A secondary analysis of two randomized controlled trials

“…4,5 Dunietz et al found that even those with moderately elevated blood pressure (BP) during pregnancy (two readings of either systolic blood pressure (SBP) ≥120 mmHg or diastolic BP ≥80 mmHg) had an increased risk of developing hypertension after 7 to 10 years, and longitudinal analysis of the Randomized Control trial of Low Glycemic Index Diet to Prevent Macrosomia in Euglycemic Women trial (ROLO trial) demonstrated that those with moderately elevated BP at 28 and 34 weeks' gestation were more likely to be diagnosed with Stage 1 or 2 hypertension at a 5-year follow-up. [6][7][8] It is therefore of great clinical relevance to evaluate lifestyle factors which may prevent elevation of BP during pregnancy.…”