(743) Association between adverse pregnancy outcomes and awareness of cardiovascular risk factors: a NuMoM2b-HHS secondary analysis

Adverse pregnancy outcomes (APOs) complicate up to 20% of pregnancies and are associated with increased risk of subsequent cardiovascular (CV) disease. We aimed to determine whether having had an APO is associated with greater patient awareness of their own CV risk factors 2-7 years postpartum.

Study Design: This is a secondary analysis of the NuMoM2b-HHS study. We included participants with a CV risk factor (hypertension [HTN], diabetes/prediabetes [DM], and/or dyslipidemia) identified 2-7 years after index pregnancy (Table 1). We excluded patients with a CV risk factor during the index pregnancy; a subsequent pregnancy; and patients who did not fast for their blood draw. Exposure was an APO in the index pregnancy: hypertensive disorders of pregnancy, gestational DM, preterm delivery, small-for-gestational age, and stillbirth. The primary outcome is a composite of self-awareness of HTN, DM, or dyslipidemia diagnoses after the index pregnancy utilizing patient questionnaire data. Using logistic regression, we estimated the association between exposure and outcome using three models (unadjusted, fully adjusted, and parsimonious).

Results:

Among 980 included participants with CV risk factors identified 2-7 years after the index pregnancy, 77% had only one risk factor with the most common being HTN (34%). APO was present in 35% of patients with the most common being hypertensive disorders of pregnancy. The primary outcome (awareness of a CV risk factor) was present in 22% of women (220/980) - 26% of women with an APO versus 20% without. Prior to adjustment, odds ratio (OR) of APO history and awareness of later CV risk factors was 1.379 (95% CI 1.013-1.877). After full adjustment and the use of a parsimonious model, there was no significant association between APO history and awareness of later CV risk factors with an OR of 1.346 (95% CI 0.974-1.859) and 1.313 (95% CI of 0.960-1.797), respectively (Figure 1).

Conclusion:

History of APO was not associated with awareness of CV risk factors 2-7 years later. Women with CV risk factors were infrequently aware of their diagnosis (22%).