Increased Cardiovascular Risk Factors in Offspring of Preeclamptic Mothers

May 22, 2012

By Will Boggs MD

NEW YORK (Reuters Health) May 21 - Cardiovascular risk factors are increased in children and young adults born to mothers with preeclampsia, researchers from the UK have found.

"Our paper now demonstrates, based on studies involving nearly 50,000 people, that being born to a pregnancy complicated by preeclampsia, whether you are a man or woman, is associated with higher levels of risk factors for cardiovascular disease from early in life, specifically higher blood pressure," Dr. Paul Leeson from the University of Oxford told Reuters Health in an email.

In Pediatrics today, he and his colleagues present data from their systematic review of studies that reported on cardiovascular risk factors in children and young adults exposed to preeclampsia in utero.

The 18 studies reviewed included data on 45,249 individuals, including 1,241 with exposure to preeclampsia.

In the 10 studies with blood pressure data, offspring of preeclamptic women had a 2.39 mm Hg greater systolic and 1.35 mm Hg greater diastolic blood pressure. Results for systolic blood pressure were similar for men and women, but diastolic blood pressure was increased significantly only among women.

"If the 2.4 mm Hg difference in systolic blood pressure tracks into adulthood," the researchers note, "this difference would be associated with an (approximately) 8% increased risk of mortality from ischemic heart disease and a 12% increased risk from stroke."

Blood pressure increases were similar in studies of children aged less than10 years at the time of follow-up and in studies of older individuals, and increases persisted in term-born offspring and those with mean birth weight above 2.5 kg.

In eight studies that compared body mass index (BMI), there was no significant increase in BMI among children less than10 years, but there was a significant increase in BMI among those 10 years and older.

The 10 studies that considered lipid levels found increases in triglycerides, total cholesterol, and LDL cholesterol and decreases in HDL cholesterol, but the two studies that examined glucose metabolism found no differences in serum insulin, glucose, or glucose-to-insulin ratio at age 12.

By young adulthood, though, the preterm offspring of preeclamptic mothers had a significantly increased fasting glucose level.

"From a public health perspective," the investigators conclude, "children born to a pregnancy complicated by preeclampsia appear to have a unique, lifetime cardiovascular risk profile that is present from early life, and so may constitute a population that may benefit from risk profile monitoring and early implementation of primary prevention strategies."

"Current advice from the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents advises blood pressure measurements in children aged over three years when seen in a medical setting and in those under three years if a history of prematurity or very low birthweight," Dr. Leeson added. "It may be worth considering whether a history of preeclampsia should also be included in this list."

"If the physician is consulted by someone who has developed high blood pressure, in particular if it has developed early in life, it is likely to be of value to know whether they were born following a pregnancy complicated by preeclampsia," Dr. Leeson said. "This might help them better understand why they have developed higher blood pressure. In women, this history will also help advise how likely they are to develop preeclampsia themselves if they become pregnant."

"The other point, which is worth remembering, is that the mother who had preeclampsia is also at increased cardiovascular risk and should have closer monitoring of risk factors such as blood pressure after the pregnancy," he continued. "Indeed, there may be value in developing combined advice for both mother and offspring following a pregnancy complicated by preeclampsia."

SOURCE: http://bit.ly/LbkqvJ

Pediatrics 2012;129:e1552-e1561.

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