Adriëtte Oostvogels

34 Chapter 2 Abstract Objective: Although prepregnancy weight status and early pregnancy lipid profile are known to influence blood pressure course during pregnancy, little is known about how these two factors interact. The association between prepregnancy weight status and blood pressure course during pregnancy was assessed in the prospective ABCD study and the role (independent/mediating/ moderating) of early pregnancy lipid profile in this association was determined. Methods: We included 2500 women with normal weight (<25 kg/m 2 ) and 600 with overweight (≥25 kg/m 2 ) from the prospective ABCD-study with available measurements of non-fasting early pregnancy lipids [median (IQR): 13 (12-14) weeks of gestation] and blood pressure during pregnancy [mean (SD)=10 (2.3)]. Lipids (triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B and free fatty acids) were divided into tertiles. Multilevel piecewise linear spline models were used to describe the course of systolic and diastolic blood pressure (SBP/DBP) in four time periods during gestation for women with normal weight and overweight. Results: Both SBP (5.3 mmHg) and DBP (3.9 mmHg) were higher in women with overweight compared to women with normal weight and this difference remained the same over all four time periods. The difference in SBP and DBP was not mediated or moderated by the lipid profile. Lipid profile had an independent positive effect on both SBP (range 1.3-2.2 mmHg) and DBP (0.8-1.1 mmHg), but did not change blood pressure course. Conclusions: Both prepregnancy weight status and early pregnancy lipid profile independently increase blood pressure during pregnancy. Improving prepregnancy weight status and early pregnancy lipid profile might result in a healthier blood pressure course during pregnancy.