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Preconception Cardiovascular Risk Factors and Pregnancy Outcome

Harville, Emily W.a; Viikari, Jorma S. A.b; Raitakari, Olli T.c

doi: 10.1097/EDE.0b013e318225c960

Background: Pregnancy-related cardiovascular conditions are associated with both poorer pregnancy outcomes and cardiovascular disease later in life. Little is known about the relationship between preconception cardiovascular risk factor levels and pregnancy complications.

Methods: Data from the Cardiovascular Risk in Young Finns Study were linked with birth registry data for 1142 primiparous women. Age-standardized levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, insulin, and glucose from the study visit prior to last menstrual period were calculated. These factors were examined as predictors of gestational age, preterm birth (<37 weeks), birthweight, low birthweight (<2500 g), small-for-gestational-age (weight <10th percentile for gestational age), hypertensive disorders of pregnancy, and gestational diabetes, using linear and Poisson regression with adjustment for age, body mass index, smoking, and socioeconomic status.

Results: Higher triglycerides were associated with a higher risk of hypertensive disorders (adjusted risk ratio [aRR] = 1.42 [95% confidence interval (CI) = 0.90-2.23]), preeclampsia (1.70 [1.08-2.65]), and gestational diabetes (1.68 [1.25-2.25]). After removing women with pregnancy complications (n = 30), the estimated aRR for the association between systolic blood pressure and preterm birth was 1.23 (95% CI = 0.99-1.54); for HDL-c and low birthweight, 0.97 (0.73-1.28); for diastolic blood pressure and small-for-gestational-age, 0.98 (0.81-1.20); and for systolic blood pressure and small-for-gestational-age, 1.18 (0.97-1.45).

Conclusions: High lipid levels before pregnancy predict an increased risk of preeclampsia and gestational diabetes. Reported associations between these pregnancy complications and later cardiovascular disease of the mother are probably explained, at least in part, by maternal conditions that precede pregnancy. Interventions to improve cardiovascular health before pregnancy may reduce risk of pregnancy complications.


From the aDepartment of Epidemiology, Tulane University School of Public Health, New Orleans, LA; bDepartment of Medicine, University of Turku and Turku University Hospital, Turku, Finland; and cThe Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Department of Clinical Physiology, Turku University Hospital, Turku, Finland.

Submitted 8 October 2010; accepted 24 March 2011; posted 27 June 2011.

Supported by the National Institute of Child Health and Human Development (K12HD043451 to EWH). The Cardiovascular Risk in Young Finns study was supported financially by the Academy of Finland (grants 117797, 126925, and 121584), Social Insurance Institution of Finland, Turku University Foundation, special federal grants for Turku University Central Hospital, Juho Vainio Foundation, Finnish Foundation of Cardiovascular Research, Finnish Cultural Foundation, and Orion Farmos Research Foundation.

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Correspondence: Emily Harville, 1440 Canal St. SL-18, New Orleans, LA 70112-2715. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.