Associations of maternal cardiovascular health in pregnancy with offspring cardiovascular health in early adolescence

Abstract

IMPORTANCE Pregnancy may be a key window to optimize cardiovascular health (CVH) for the mother and influence lifelong CVH for her child. OBJECTIVE To examine associations between maternal gestational CVH and offspring CVH. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study (examinations: July 2000-April 2006) and HAPO Follow-Up Study (examinations: February 2013-December 2016). The analyses included 2302 mother-child dyads, comprising 48%of HAPO Follow-Up Study participants, in an ancillary CVH study. Participants were from 9 field centers across the United States, Barbados, United Kingdom, China, Thailand, and Canada. EXPOSURES Maternal gestational CVH at a target of 28 weeks' gestation, based on 5 metrics: body mass index, blood pressure, total cholesterol level, glucose level, and smoking. Each metric was categorized as ideal, intermediate, or poor using pregnancy guidelines. Total CVH was categorized as follows: all ideal metrics, 1 or more intermediate (but 0 poor) metrics, 1 poor metric, or 2 or more poor metrics. MAIN OUTCOMES AND MEASURES Offspring CVH at ages 10 to 14 years, based on 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Total CVH was categorized as for mothers. RESULTS Among 2302 dyads, the mean (SD) ages were 29.6 (2.7) years for pregnant mothers and 11.3 (1.1) years for children. During pregnancy, the mean (SD) maternal CVH score was 8.6 (1.4) out of 10. As shown in the Table, 32.8%of pregnant mothers had all ideal metrics, whereas 6.0% had 2 or more poor metrics, and the distribution of CVH categories among offspring varied by maternal CVH category. In adjusted models, poorer maternal CVH categories (vs all ideal maternal metrics) were associated with higher relative risks for offspring to have 1 poor and 2 or more poor metrics (vs all ideal metrics). {table presented} Additional adjustment for categorical birth factors (eg, preeclampsia) did not fully explain these significant associations (eg, relative risk for association between 2 or more poor metrics among mothers during pregnancy and 2 or more poor metrics among offspring after adjustment for an extended set of birth factors, 6.23 [95%CI, 3.03-12.82]). CONCLUSIONS AND RELEVANCE In this multinational cohort, better maternal CVH at 28 weeks' gestation was significantly associated with better offspring CVH at ages 10 to 14 years.