Abstract P176: Heart-Healthy Dietary Patterns Are Inversely Related to Hypertension Among Women With History of Preeclampsia: A Cohort Study in Mexico
Authors: Arvizu Mariel , Cortes Adrian , Monge Adriana , Lajous Martin , López-Ridaura Ruy , Gaskins Audrey J , Rosner Bernard , Rich-Edwards Janet , Chavarro Jorge E 
Published: March 2019

Objective:
Although history of preeclampsia increases a woman′s risk of developing hypertension (HTN) in adulthood, it remains unclear whether a heart-healthy post-pregnancy diet could ameliorate some of this risk. Therefore, we evaluated whether adherence to dietary patterns is related with HTN among women with prior preeclampsia

Methods:
At baseline, 4,781 women without HTN reported at least one pregnancy with preeclampsia in the 2008 Mexican Teachers’ Cohort follow-up cycle. From the baseline food frequency questionnaire (FFQ) we derived diet scores based on the American Heart Association (AHA) 2020 Goals and the Dietary Approaches to Stop Hypertension (DASH). The AHA score has 5 items: fruits and vegetables, fish, whole grain, sugar-sweetened beverages and sodium, whereas the DASH diet has 8: low-fat dairy, nuts/legumes, fruits, vegetables, whole grain, red and processed meats, sugar-sweetened beverages, and sodium. Incident HTN reported in 2011, was defined as high blood pressure diagnosed by a medical doctor or currently taking antihypertensive treatment. We estimated the relative risk (RR) and 95% confidence intervals (95%CI) of HTN by comparing women in the lowest score quintile to women in the highest score quintile, using log-binomial regression after adjusting for common risk factors for HTN as well as health care provider, demographic regions and indigenous heritage.

Results:
The mean age (SD) of women affected by preeclampsia was 41(7) years and BMI of 28(5) kg/m
2
. Over the 3-year study period, 555(12%) women developed incident HTN, which was higher that the incidence of HTN among women with normotensive pregnancies (6%). Women with the highest AHA scores had 0.82(95% CI 0.68,1.06) times the risk of developing HTN than women with lowest scores (p-trend=0.04). Similarly, highest adherence to the DASH diet had 0.74(95% CI 0.57,0.96) times the risk of developing HTN than women with the lowest score(p-trend=0.03). When individual components of the diet were separately evaluated, only sodium intake was associated with HTN. Specifically, women who consumed ≥2,500 mg/day of sodium had 1.18(0.92,1.52) times the risk of HTN compared to women who consumed <1,500 mg/day. Adherence to the AHA and DASH scores and sodium intake were also related to risk of HTN among 57,063 women without a history of preeclampsia; however the associations were weaker for highest adherence to AHA (RR 0.86 [95%CI 0.78,0.96]),DASH RR 0.87 [95%CI 0.78, 0.97]),and RR 1.13 [95% CI 1.01,1.26] for ≥2,500 vs. <1,500 mg/day of sodium.

Conclusion:
Greater adherence to AHA and DASH diet patterns were inversely related to risk of HTN among Mexican women with a history of preeclampsia and even though lower sodium intake was also related to HTN, the FFQ underestimates absolute sodium intake. Nevertheless, post-partum recommendations on diet quality in this high-risk group may provide one strategy to prevent long-term risk of HTN.