Achieving and maintaining a healthy weight before pregnancy may be instrumental in promoting maternal health and reducing future heart disease risk, according to findings from an observational study published April 14 in JACC.

Researchers tracked outcomes over 10 to 14 years in 4,269 pregnant women across nine countries to assess whether adverse pregnancy outcomes (APOs) are a marker or mediator of prepregnancy BMI and later development of risk factors for cardiovascular disease. The mean maternal age of participants was 30 years and 10.6% had prepregnancy obesity.

Results showed that gestational diabetes mellitus (GDM) occurred in 13.8% of participants and new-onset hypertensive disorders of pregnancy occurred in 10.7%. Participants with obesity compared with normal prepregancy BMI, at a mean age at follow-up of 41.7 years, had a higher mean arterial pressure (7.0 mm Hg), triglycerides (28.5 mg/dL) and HbA1c (0.3%).

Additionally, the association between obesity and HbA1c was partially mediated by GDM (24.6%), whereas new-onset HDP partially mediated the association between obesity and mean arterial pressure (12.4%).

The authors write that APOs mediated a small proportion of the association between prepregnancy and cardiovascular disease in mid-life.

"The study highlights the significance of [APOs] as a risk-enhancing factor for cardiovascular disease," says Jaclyn D. Borrowman, PhD, the study's lead author. "Our results also suggest that prioritizing weight management among those considering pregnancy may promote both maternal and future cardiovascular health."

In an accompanying editorial comment, Garima Sharma, MBBS, FACC; Tiffany M. Powell-Wiley, MD; and Tiffany L. Brazile, MD, note that the study provides "insightful information" that could help guide screening, counseling and management. "The results of the study underscore the value in addressing excess adiposity in the prepregnancy and postpartum period, particularly as there are options with emerging therapies such new anti-obesity medications," says Sharma.