1 Department of Cardiology, University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania.
2 Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
Breastfeed Med. 2019 Jul/Aug;14(6):408-415. doi: 10.1089/bfm.2018.0153. Epub 2019 Mar 15.
Women with hypertensive disorders of pregnancy are at increased risk of cardiovascular disease in later life. We sought to determine the association between lactation and markers of maternal cardiovascular health among postpartum women with and without hypertensive disorders of pregnancy via measures of inflammation (high-sensitivity C-reactive protein [hsCRP]) and renal function (cystatin C). This prospective cohort study enrolled primarily overweight and obese women during early pregnancy. At a postpartum study visit occurring 6-24 months after delivery, we collected data on lactation duration and measured hsCRP and cystatin C. We assessed associations between lactation duration and levels of hsCRP and cystatin C among normotensive women and women with preeclampsia or gestational hypertension using analysis of variance and chi-squared tests. Linear regression models adjusted for age, race, education, prepregnancy body mass index, current smoking, and time since delivery. Of 425 women, 37 (9%) had preeclampsia and 48 (11%) had gestational hypertension during enrollment pregnancy. The postpartum visit occurred at a mean of 8.6 ± 4.4 months after delivery. Women with a history of preeclampsia had significantly higher levels of cystatin C (mean 0.86 versus 0.78 mg/L; = 0.03) compared with normotensive women, but nonsignificant elevation in hsCRP (mean 8.39 versus 6.04 mg/L; = 0.08). Women with gestational hypertension had no differences in mean hsCRP or cystatin C compared with normotensive women. Among the 237 women with any lactation, 78 (18%) lactated for at least 6 months. Lactation duration both in the overall sample and among women with gestational hypertension or preeclampsia was not associated with levels of hsCRP or cystatin C. Preeclampsia history was associated with elevated postpartum levels of cystatin C; however, duration of lactation was not associated with postpartum hsCRP or cystatin C, regardless of history of gestational hypertension or preeclampsia. Further research is needed on mechanisms through which lactation may affect maternal risk of cardiovascular disease.
患有妊娠高血压疾病的女性在以后的生活中患心血管疾病的风险增加。我们旨在通过炎症标志物（高敏 C 反应蛋白 [hsCRP]）和肾功能标志物（胱抑素 C）来确定患有和未患有妊娠高血压疾病的产后妇女的哺乳与母体心血管健康标志物之间的关联。这项前瞻性队列研究主要在妊娠早期招募超重和肥胖的女性。在产后研究访视中，即在分娩后 6-24 个月时，我们收集了哺乳时间的数据，并测量了 hsCRP 和胱抑素 C。我们使用方差分析和卡方检验评估了哺乳时间与正常血压女性以及子痫前期或妊娠期高血压女性的 hsCRP 和胱抑素 C 水平之间的关联。线性回归模型调整了年龄、种族、教育程度、孕前体重指数、当前吸烟和分娩后时间。在 425 名女性中，37 名（9%）在入组妊娠时患有子痫前期，48 名（11%）患有妊娠期高血压。产后访视发生在分娩后平均 8.6±4.4 个月。患有子痫前期的女性胱抑素 C 水平显著升高（平均 0.86 与 0.78mg/L； = 0.03），而 hsCRP 水平升高不显著（平均 8.39 与 6.04mg/L； = 0.08）。与正常血压女性相比，患有妊娠期高血压的女性的 hsCRP 或胱抑素 C 均值没有差异。在 237 名有任何哺乳的女性中，78 名（18%）至少哺乳 6 个月。总体样本以及患有妊娠期高血压或子痫前期的女性的哺乳时间与 hsCRP 或胱抑素 C 水平均无关联。子痫前期病史与产后胱抑素 C 水平升高有关；然而，无论是否患有妊娠期高血压或子痫前期，哺乳时间均与产后 hsCRP 或胱抑素 C 无关。需要进一步研究哺乳通过何种机制可能影响女性患心血管疾病的风险。
