Association of NT-proBNP in Early Pregnancy and Development of Hypertensive Disorders

Quick Takes

  • Higher NT-proBNP concentrations in early pregnancy were associated with a lower risk of hypertensive disorders of pregnancy after controlling for early-pregnancy blood pressure and traditional risk factors.
  • Women with higher NT-proBNP concentrations in early pregnancy also had lower risk of hypertension at 2–7 years post-partum after controlling for adverse pregnancy outcomes and confounders.
  • Early-pregnancy cardiovascular physiology, as assessed with NT-proBNP concentration, may be an important determinant of both pregnancy outcome as well as risk of future cardiovascular disease.

Study Questions:

What is the association of higher concentrations of N-terminal pro–B-type natriuretic peptide (NT-proBNP) in early pregnancy with hypertensive disorders of pregnancy and hypertension 2–7 years post-partum?

Methods:

The investigators conducted a cohort study and used data from The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study, a prospective multicenter observational study. A total of 4,103 nulliparous women with complete data and no prepregnancy hypertension or diabetes who were treated at eight clinical sites were included. Women were followed up for 2–7 years after pregnancy. Data were collected from October 2010–October 2017, and data were analyzed from August 2020–November 2021. NT-proBNP concentration was measured using an electrochemiluminescence immunoassay from a first-trimester blood sample. The main outcomes measure was hypertensive disorders of pregnancy and incident hypertension (systolic blood pressure of 130 mm Hg or diastolic blood pressure of 80 mm Hg or use of antihypertensive agents) at follow-up visit.

Results:

A total of 4,103 women met inclusion criteria; the mean (standard deviation) age was 27.0 (5.6) years. Among these women, 909 (22.2%) had an adverse pregnancy outcome, and 817 (19.9%) had hypertension at the follow-up visit. Higher NT-proBNP concentrations were associated with a lower risk of hypertensive disorders of pregnancy (adjusted odds ratio per doubling, 0.81; 95% confidence interval, 0.73-0.91), which persisted after adjustment for age, self-reported race and ethnicity, early-pregnancy body mass index, smoking, and aspirin use. Similarly, higher NT-proBNP concentration in early pregnancy was also associated with a lower risk of incident hypertension 2–7 years after delivery (adjusted odds ratio per doubling, 0.84; 95% confidence interval, 0.77-0.93), an association that persisted after controlling for confounders, including hypertensive disorders of pregnancy.

Conclusions:

The authors concluded that higher NT-proBNP concentrations in early pregnancy were associated with a lower risk of hypertensive disorders of pregnancy and hypertension 2–7 years post-partum.

Perspective:

This study reports that higher NT-proBNP concentrations in early pregnancy were associated with a lower risk of hypertensive disorders of pregnancy after controlling for early-pregnancy blood pressure and traditional risk factors. Furthermore, women with higher NT-proBNP concentrations in early pregnancy had lower risk of hypertension at 2–7 years post-partum, even after controlling for adverse pregnancy outcomes and confounders. The findings underscore the importance of early-pregnancy cardiovascular adaptation not only for healthy pregnancy outcomes but also as a marker of future cardiovascular health. In sum, these data suggest that early-pregnancy cardiovascular physiology, as assessed with NT-proBNP concentration, may be an important determinant of both pregnancy outcome as well as risk of future cardiovascular disease.

Keywords: Antihypertensive Agents, Aspirin, Blood Pressure, Diabetes Mellitus, Hypertension, Hypertension, Pregnancy-Induced, Natriuretic Peptide, Brain, Postpartum Period, Pregnancy, Pregnancy Outcome, Primary Prevention, Risk Factors, Smoking, Vascular Diseases, Women


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