IMPORTANCE Hypertensive disorders of pregnancy are associated with future cardiovascular disease, perhaps because of subclinical cardiac dysfunction before pregnancy leading to impaired adaptation to pregnancy. Natriuretic peptides are promising biomarkers for detecting subclinical cardiac dysfunction outside of pregnancy. OBJECTIVE To investigate whether higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) in early pregnancy would be associated with hypertensive disorders of pregnancy and hypertension 2 to 7 years post partum. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study, a prospective multicenter observational study. A total of 4103 nulliparous women with complete data and no prepregnancy hypertension or diabetes who were treated at 8 clinical sites were included. Women were followed up with for 2 to 7 years after pregnancy. Data were collected from October 2010 to October 2017, and data were analyzed from August 2020 to November 2021. EXPOSURES NT-proBNP concentration, measured using an electrochemiluminescence immunoassay from a first-trimester blood sample. MAIN OUTCOMES AND MEASURES 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 4103 women met inclusion criteria; the mean (SD) 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% CI, 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 to 7 years after delivery (adjusted odds ratio per doubling, 0.84; 95% CI, 0.77-0.93), an association that persisted after controlling for confounders, including hypertensive disorders of pregnancy. CONCLUSIONS AND RELEVANCE In this cohort study, higher NT-proBNP concentrations in early pregnancy were associated with a lower risk of hypertensive disorders of pregnancy and hypertension 2 to 7 years post partum. These findings suggest that normal early-pregnancy cardiovascular physiology, as assessed by NT-proBNP concentration, may provide biologic insights into both pregnancy outcome and cardiovascular disease risk.

中文翻译：

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妊娠早期 N 端脑钠肽前体浓度与妊娠期高血压疾病和未来高血压的关系。


重要性 妊娠期高血压疾病与未来的心血管疾病有关，可能是因为妊娠前亚临床心功能不全导致对妊娠的适应受损。利尿钠肽是检测妊娠期外亚临床心功能障碍的有前途的生物标志物。目的 探讨妊娠早期较高浓度的 N 末端脑钠肽前体 (NT-proBNP) 是否与妊娠高血压疾病和产后 2 至 7 年高血压相关。设计、设置和参与者 这项队列研究使用了未产儿妊娠结局研究：监测准妈妈心脏健康研究的数据，这是一项前瞻性多中心观察性研究。共纳入 4103 名数据完整、无孕前高血压或糖尿病且在 8 个临床中心接受治疗的未生育妇女。妇女在怀孕后进行2至7年的随访。数据收集时间为 2010 年 10 月至 2017 年 10 月，数据分析时间为 2020 年 8 月至 2021 年 11 月。 暴露 NT-proBNP 浓度，使用电化学发光免疫分析法对妊娠早期的血液样本进行测量。主要结果和措施 妊娠期高血压疾病和随访时发生的高血压（收缩压 130 mm Hg 或舒张压 80 mm Hg 或使用抗高血压药物）。结果 共有 4103 名女性符合纳入标准；平均 (SD) 年龄为 27.0 (5.6) 岁。在这些女性中，909 名（22.2%）有不良妊娠结局，817 名（19.9%）在随访时患有高血压。较高的 NT-proBNP 浓度与较低的妊娠高血压疾病风险相关（调整后的比值比每倍为 0。81； 95% CI，0.73-0.91），在调整年龄、自我报告的种族和民族、早孕体重指数、吸烟和阿司匹林使用后，这一结果仍然存在。同样，妊娠早期较高的 NT-proBNP 浓度也与产后 2 至 7 年发生高血压的风险较低相关（每倍调整比值比，0.84；95% CI，0.77-0.93），这种关联在控制后仍然存在。混杂因素，包括妊娠期高血压疾病。结论和相关性 在这项队列研究中，妊娠早期较高的 NT-proBNP 浓度与妊娠期高血压疾病和产后 2 至 7 年高血压的风险较低相关。这些发现表明，通过 NT-proBNP 浓度评估的正常早期妊娠心血管生理学可能为妊娠结局和心血管疾病风险提供生物学见解。