Cardiovascular Health During Pregnancy Helps Predict Heart Health in Children, Study Finds

Amanda Perak, MD

In what investigators are calling the first study of its kind, new research from Northwestern Medicine suggests the cardiovascular health of a mother during her first pregnancy could offer insight into the long-term health of her children.

An analysis of more than 2000 mother-child pairs indicates maternal cardiovascular health at 28 weeks’ gestation, which was assessed based on BMI, blood pressure, and other factors, can help predict offspring cardiovascular health between 10-14 years age.

"Our new findings suggest that the children of this large group of mothers with suboptimal cardiovascular health may be at higher risk for early declines in their own cardiovascular health during childhood," said lead investigator Amanda Perak, MD, assistant professor of pediatrics and preventive medicine at Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, in a statement. "If we can address these underlying causes of children's poor heart health, we can hopefully help them avoid future heart attacks, strokes and premature deaths as they grow up."

Using data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and HAPO Follow-up study, Perak and a team of colleagues from Northwestern and Lurie Children’s Hospital designed their study with the hope of assessing how maternal cardiovascular health during pregnancy might be associated with offspring cardiovascular health in adolescence. From the studies, investigators identified a cohort of 2302 mother-child dyads from 9 centers in multiple countries for inclusion. Of note, this represents 48% of the HAPO Follow-up study population.

For the purpose of analysis, cardiovascular health was assessed according to 5 metrics: BMI, blood pressure, total cholesterol levels, glucose level, and smoking status. Mothers underwent assessments of each of these metrics at 28 weeks’ gestation. For their offspring, investigators assessed cardiovascular health using 4 metrics: BMI, blood pressure, total cholesterol levels, and glucose level, which were assessed between the ages of 10-14 years. Scores for mothers ranged from 0-10 and scores for offspring ranged from 0-8.

From the HAPO studies, investigators obtained disinformation related to maternal demographics, parity, and alcohol use through patient questionnaires. Additionally, maternal gestational age was determined by last menstrual period or an ultrasound. All of these factors were used as covariates in fully-adjusted analysis.

Among the dyads included in the study, mothers had a mean age of 29.6 (SD, 2.7) years and children had a mean age of 11.3 (SD, 1.1) years. During pregnancy, mothers had a mean maternal cardiovascular health score of 8.6 out of 10.

Upon analysis, 32.8% of pregnant mothers had metrics considered ideal, but 6.0% had 2 or more poor metrics and the distribution of cardiovascular health categories among offspring varied according to maternal cardiovascular health category. In adjusted models, results indicated women with worse maternal cardiovascular health, which was defined as having 2 or more poor metrics, had a greater relative risk of having offspring with 1 (RR, 2.02; 95% CI, 1.55-2.64) and 2 or more (RR, 7.82; 95% CI, 4.12-14.85) poor metrics when compared to mothers with ideal metrics.

In fully-adjusted models, which accounted for birth factors including preeclampsia, did not fully explain significant associations observed in the other analyses. Specifically, results indicated children born to mothers with 2 or more poor metrics during pregnancy were at a 6.23-fold increase in risk of having 2 or more poor metrics at follow-up (RR, 6.23; 95% CI, 3.03-12.82).

"Our study combined multiple factors across a range of levels, and found that the associations of maternal cardiovascular health with offspring cardiovascular health were not driven by any one metric (such as obesity)," Perak added. "Instead, all metrics were related to the offspring's later health."

This study, “Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence,” was published in JAMA.