Adolescent Cardiovascular Risk Trajectories and Later-Life Maternal Morbidity

Importance: There is an increasing burden of cardiovascular-related morbidity in pregnancy. To avert excess cardiovascular health (CVH) risks, a clearer understanding of the association between adolescent and young-adult cardiovascular risks and future pregnancy health is warranted. Objective: To assess the association of cardiovascular risk in adolescence and young adulthood with later-life adverse pregnancy outcomes. Design, Setting, and Participants: This cohort study used data from the National Longitudinal Study of Adolescent and Adult Health. Female participants interviewed in 1994-1996 (ages 11-19 years), 2001-2002 (ages 18-26 years), and 2016-2018 (ages 34-43 years) without juvenile-onset diabetes or hypertension and with reported birth data were included in the sample. Exposure: CVH risk in adolescence and young adulthood was categorized as low, medium, or high using an adapted Life's Essential 8 scale (range: 0-100, with a score of 0 representing poor CVH status and 100 indicating optimal CVH status). Main Outcomes and Measures: The primary outcome was a self-reported history of gestational diabetes (GD) or hypertensive disorder of pregnancy (HDP) between survey waves 3 and 5. Associations between adolescent CVH and future GD or HDP were estimated using log-binomial regression, adjusting for maternal characteristics and sociodemographic factors. Analyses accounted for the sampling design by controlling for clustered data and unequal probability of selection and were weighted to represent population-level estimates. Results: The sample included 1094 female participants (median [IQR] age, 16 [14-17] years) with a median (IQR) body mass index (calculated as weight in kilograms divided by height in meters squared) of 21.6 (19.6-24.5). Participants with poor adolescent CVH compared with optimal adolescent CVH had an adjusted risk ratio (ARR) of 2.01 (95% CI, 0.96-4.24) for a future elevated risk of GD. The ARR for future GD for intermediate (vs optimal) CVH was 1.04 (95% CI, 0.53-2.07). The highest incidence of GD was observed among participants with poor CVH during adolescence and young adulthood (28.5%) compared with an incidence of 9.6% among those with intermediate CVH and 4.7% among those with optimal CVH during adolescence and young adulthood. Participants with poor adolescent CVH who had optimal or intermediate CVH in young adulthood had a 24.9% and 14.7% incidence of GD, respectively. Compared with optimal CVH status, poor adolescent CVH had an ARR of 1.22 (95% CI, 0.74-2.01), and intermediate adolescent CVH had an ARR of 1.43 (95% CI, 0.93-2.21) for a future elevated risk of HDP. Conclusions and Relevance: In this cohort study, the incidence of GD was higher among those with poor CVH in adolescence and young adulthood. Achieving optimal CVH in adolescence may reduce the risk of GD in adulthood.