Study shows poor cardiovascular maternal health in pregnancy puts offspring at risk

The better a mother’s cardiovascular health during pregnancy, the more likely her child will be heart healthy during adolescence, according to an international cohort study.

Researchers found that poorer maternal cardiovascular health at 28 weeks’ gestation — based on metrics including body mass index, blood pressure, total cholesterol level, glucose level, and smoking — was significantly associated with higher risks of poorer offspring cardiovascular health at ages 10-14 years

The study, by Amanda M. Perak, MD, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, and colleagues, was published in JAMA.

The authors noted that studies have shown high risk factors in the case of conditions such as diabetes, obesity, and hypertensive disorders during pregnancy have been associated with a greater risk of cardiovascular disease in offspring. However, they added, “combinations of risk factor levels that are non-ideal but below clinical diagnostic thresholds are more common and may contribute more to population disease burdens.”

In an editorial accompanying the study, Stephen R. Daniels, MD, PhD, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, wrote that the results of this study “support the concept that fetal life may be a critical period for subsequent cardiovascular health and that the mother’s cardiovascular health status during pregnancy may have a long-term influence on the cardiovascular health of her offspring.”

Daniels added that “[t]hese results also indicate that all newborns are likely not equal in terms of their cardiovascular health.”

If confirmed by more studies, he noted, the results suggest there is a need, and also opportunities, for interventions to optimize both the cardiovascular health of mothers and their offspring.

Perak and colleagues used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study and HAPO Follow-Up Study. For the current analysis, the authors included 2,302 mother-child pairs from a 50% subset of the HAPO Follow-Up Study distributed across ancestry groups (African, Asian, European, Mexican American) from field centers across the United States, Barbados, United Kingdom, China, Thailand, and Canada.

Perak and colleagues wanted to evaluate associations of maternal cardiovascular health during pregnancy — defined as a combination of five clinical metrics that include BMI, blood pressure, total cholesterol level, glucose level, and smoking — on the cardiovascular health of children in early adolescence (ages 10-14). Offspring were evaluated based on the same metrics, with the exception of smoking.

Each of the clinical metrics was categorized as ideal and assigned 2 points, intermediate (1 point), or poor (0 points). This yielded a possible maternal cardiovascular health score of 0 to 10 points and a possible offspring cardiovascular health score of 0 to 8. For both groups, cardiovascular health was also categorized into four mutually exclusive groups: all ideal metrics, one or more intermediate (but no poor) metrics, one poor metric, or two or more poor metrics.

Perak and colleagues found that during pregnancy, the mean (SD) maternal cardiovascular health (CVH) score was 8.6 (1.4) out of 10, with 32.8% of mothers having all ideal metrics while 6.0% had two or more poor metrics. At follow-up, the mean (SD) offspring CVH score was 6.8 (1.3) out of 8, and 37.3% of children had all ideal metrics, and 4.5% had two or more poor metrics

The percentage of children who had all ideal metrics fell from 42.2% among those exposed to all ideal gestational CVH metrics to 30.7% among those exposed to two or more poor gestational CVH metrics. The prevalence of children who had one poor metric, or two or more poor metrics, was 18.4% and 2.6%, respectively, among those exposed to all ideal gestational CVH metrics. These percentages increased to 30.7% and 10.2%, respectively, among those to exposed to two or more poor gestational CVH metrics.

Each 1-point higher gestational total cardiovascular health score in the mother was associated with significantly better cardiovascular health in the offspring at ages 10 to 14 years, including a 0.19-point higher cardiovascular health score (out of 8 possible points), a relative risk of 1.15 for having all ideal (versus any non-ideal) cardiovascular health metrics, and a relative risk of 0.65 for having two or more poor (vs all ideal) metrics.

On the other hand, poorer maternal cardiovascular health was significantly associated with a higher risk of poorer offspring cardiovascular health, with an adjusted relative risk of 7.82 for an association between two poor [vs all ideal] maternal metrics and two poor [versus all ideal] offspring metrics.

“Given these findings, gestational CVH may merit further study as a potential prenatal target for prevention of poor CVH by adolescence in offspring,” wrote Perak and colleagues. “Because CVH is broadly applicable for adults and youths outside of pregnancy, clinical use of CVH during pregnancy as well could provide a consistent and relatively simple means of monitoring and messaging global health across the life course.”

In his editorial, Daniels noted that more work is needed to build upon these study results. For example, how is “optimum cardiovascular health defined for pregnant women,” given the rapidly changing physiology during pregnancy? Also, at what point during gestation should cardiovascular health status be determined? “It seems certain that the mother’s prepregnancy cardiovascular health is important because maternal prepregnancy BMI has been shown to be important for certain outcomes in offspring.”

Daniels also pointed out that Perak and colleagues did not include diet or physical activity variables in their study. “Moreover, the level of cardiovascular health for the mothers at the time it was measured when their children were ages 10 to 14 years is unknown. This information could provide some indication of lifestyle factors in the family after birth and into childhood and adolescences.”

Nonetheless, Daniels noted that the study “sets the stage for work that will address these issues.” Ideally, “it seems prudent for mothers to focus on a healthy lifestyle and cardiovascular health before pregnancy, during gestation, and beyond,” he added.

  1. Maternal cardiovascular health during pregnancy is signficantly associated with the child’s cardiovascular health during early adolescence.

  2. Poorer maternal cardiovascular health at a mean of 28 weeks’ gestation was significantly associated with higher risks for poorer offspring cardiovascular health at ages 10 to 14 years.

Michael Bassett, Contributing Writer, BreakingMED™

Perak reported receiving grants from the Woman’s Board of Northwestern Memorial Hospital (Eleanor Wood-Prince Grant), the Dixon Family (Dixon Translational Research Grants Initiative), and the American Heart Association (17SFRN33660752) during the conduct of the study and grants from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (K23HL145101) outside the submitted work.

Cat ID: 41

Topic ID: 83,41,730,914,41,138,192,925