Children born to mothers with obesity, gestational diabetes, or high blood pressure during pregnancy were more likely to have elevated blood pressure from early childhood through adolescence, according to a U.S. cohort study involving 12,480 mother-child pairs.
Children were followed from age 2 to 18. About 44% of mothers had at least one risk factor during pregnancy. Pre-pregnancy obesity was the most common (24.6%), followed by hypertensive disorders of pregnancy (13.6%) and gestational diabetes (6.5%).
At the first blood pressure measurement, children of mothers with any risk factor had systolic blood pressure percentiles that were, on average, 4.88 points higher, and diastolic percentiles 1.9 points higher, after adjusting for maternal age, race, education, income, and smoking status.
The combination of hypertensive disorders of pregnancy and obesity showed the strongest association, with systolic percentiles more than 7 points higher compared to children of mothers without risk factors, noted Zhongzheng Niu, PhD, and colleagues.
In the longitudinal analysis of 6,015 children with multiple blood pressure readings, those exposed to maternal risk factors showed steeper increases in blood pressure with age. Sex and racial differences were also noted. The association with diastolic blood pressure was more pronounced in girls than in boys. Among racial groups, Black children had the highest systolic percentiles in response to maternal HDP and gestational diabetes.
Although blood pressure percentiles typically declined with age in the general population, children exposed to maternal cardiometabolic conditions experienced a slower decline—or in some cases, an upward trend. The investigators suggested that in-utero exposures may influence long-term cardiovascular risk, although the mechanisms remain unclear. Shared metabolic or vascular pathways between mother and fetus may play a role in regulating blood pressure later in life.
"Implementing clinical screening and treatment guidelines to identify and treat cardiometabolic risk factors in pregnant individuals may foster better cardiovascular health in the next generation. Clinical screening and treatment guidelines that provide early identification of and protect against cardiometabolic risk factors in the childbearing population may promote healthier blood pressure in the next generation," wrote Niu, of the University of Southern California, Los Angeles, and colleagues.
Additional research is needed to clarify the biological mechanisms and assess whether early interventions could mitigate long-term cardiovascular risk in children.
"These findings are not novel, but they add substantively to the overwhelming evidence that an individual’s lifelong health is influenced by the intrauterine environment. This work further shows that maternal cardiometabolic risk factors may have an additive association with child cardiovascular health," wrote Jennifer H. Klein, MD, and Michele Mietus-Snyder, MD, in an invited editorial.
"Heightened focus on maternal health and the fetal and early neonatal environment may hold untapped primordial preventive therapeutic potential," concluded Dr. Klein and Dr. Mietus-Snyder, both of George Washington University School of Medicine and Health Sciences, Washington, DC.
Full disclosures can be found in the published study.
Source: JAMA Network Open