COMMENTARY

BP in Midlife Women: Preterm Birth and Offspring Size as Predictors

JoAnn E. Manson, MD, DrPH

Disclosures

March 02, 2021

This transcript has been edited for clarity.

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital.

I'd like to talk with you about a recent study on prior preterm and small-for-gestational-age (SGA) birth in relation to maternal blood pressure during the menopause transition. This was a recent report in the journal Menopause from the SWAN (Study of Women's Health Across the Nation) cohort.

We've known for a long time that certain pregnancy complications, such as preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes are associated with elevations in blood pressure and heightened cardiovascular risk in the mother.

Less has been known about the relationship between prior preterm or SGA birth and blood pressure trajectory. This was looked at in SWAN among 1008 women who were of diverse races and ethnicities. They had repeated blood pressure measurements. The first was measured before the final menstrual period at an average age of 46, again at the time of menopause, and then up to 10 years past menopause.

Women with a history of having a preterm birth (birth prior to 37 weeks) or a SGA birth (birth weight < 10th percentile) — each reported by about 10% of the women — were compared with women who had only full-term or appropriate-for-gestational-age births.

They found that women who had a history of SGA birth had consistently higher blood pressures at each of these time points. On average, their systolic blood pressures were 4-7 mm Hg higher, which was substantial. Diastolic blood pressures were also elevated. Women with a history of preterm birth had a significant elevation of systolic blood pressure during the postmenopause visit.

These models were adjusted for other risk factors, sociodemographic factors, BMI, lifestyle factors, and multiple medical factors, as well as prior pregnancy complications such as preeclampsia and gestational diabetes, and these risk elevations persisted.

The investigators did not see a clear difference in the rate of change in blood pressure over time. There seemed to be similar trajectories of increases; however, the women who had these birth conditions started out with higher blood pressure or had higher blood pressure at these various time points.

What did we learn from this study? It appears that a pregnancy-related condition is associated with a cardiovascular risk factor, and it suggests that particularly for women who had an SGA birth, checking blood pressure frequently and also during the premenopausal years would be indicated. This could help to lower the risk of developing hypertension and reducing future cardiovascular risk if different preventive or therapeutic modalities were instituted.

Once again, we are seeing that a pregnancy-related complication or reproductive factor provides a window into a woman's future cardiovascular health and provides guidance in terms of her clinical management.

Thank you so much for your attention. This is JoAnn Manson.

Dr JoAnn Manson is a professor of medicine at Harvard Medical School and chief of the Division of Preventive Medicine at Brigham and Women's Hospital in Boston, Massachusetts.

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