Heart Health in Pregnancy Tied to CV Risk in Adolescent Offspring

Debra L Beck

February 23, 2021

Children born to mothers in poor cardiovascular health during pregnancy had an almost eight times higher risk for landing in the poorest cardiovascular health category in early adolescence than children born to mothers who had ideal cardiovascular health during pregnancy.

In an observational cohort study that involved 2302 mother–child dyads, 6.0% of mothers and 2.6% of children were considered to be in the poorest category of cardiovascular health on the basis of specific risk factors.

The children of mothers with any "intermediate" cardiovascular health metrics in pregnancy — for example, being overweight but not obese — were at just more than two times higher risk for poor cardiovascular health in early adolescence.

Although acknowledging the limitations of observational data, Amanda M. Perak, MD, Northwestern University Feinberg School of Medicine, Chicago, suggested that focusing on whether or not the relationships seen in this study are causal might be throwing the baby out with the bathwater.

"I would suggest that it may not actually matter whether there is causality or correlation here, because if you can identify newborns at birth who have an eight times higher risk for poor cardiovascular health in childhood based on mom's health during pregnancy, that's valuable information either way," said Perak.

"Even if you don't know why their risk is elevated, you might be able to target those children for more intensive preventative efforts throughout childhood to help them hold on to their cardiovascular health for longer."

That said, she thinks it's possible that the intrauterine environment might actually directly affect offspring health, either through epigenetics modifications to cardiometabolic regulatory genes or possibly through actual organ development. Her group is collecting epigenetic data to study this further.

"We also need to do a study to see if intervening during pregnancy with mothers leads to better cardiovascular health in offspring, and that's a question we can answer with a clinical trial," said Perak.

This study was published in the February 16 issue of JAMA.

Equal Footing

"We've always talked about cardiovascular health as if everyone is born with ideal cardiovascular health and loses it from there, and I think what this article points out is that not everybody starts on equal footing," said Stephen R. Daniels, MD, PhD, University of Colorado School of Medicine, Aurora, who wrote an editorial accompanying the study.

"We need to start upstream, working with mothers before and during pregnancy, but it's also important to understand, from a pediatric standpoint, that with some of these kids, the horse is kind of already out of the barn very early."

Daniels is pediatrician-in-chief and chair of pediatrics at Children's Hospital Colorado.

This study is the first to examine the relevance of maternal gestational cardiovascular health to offspring cardiovascular health and an important first step toward developing new approaches to address the concept of primordial prevention, he said.

"If primary prevention is identifying risk factors and treating them, I think of primordial prevention as preventing the development of those risk factors in the first place," said Daniels.

Future trials, he added, should focus on the various mechanistic pathways — biological effects, shared genetics, and lifestyle being the options — to better understand opportunities for intervention.

Mother–Child Pairs

Perak and colleagues used data from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and the HAPO Follow-up Study.

Participants were 2302 mother–child pairs from nine field centers in Barbados, Canada, China, Thailand, United Kingdom, and the United States, and represented a racially and ethnically diverse cohort.

The mean ages were 29.6 years for pregnant mothers and 11.3 years for children. The pregnancies occurred between 2000 and 2006, and the children were examined from 2013 to 2016, when the children were 10 to 14 years f age.

Using the American Heart Association's definition of cardiovascular health, the scientists categorized pregnancy health for mothers based on their measures of body mass index, blood pressure, total cholesterol, glucose level, and smoking status at 28 weeks' gestation. These five metrics of gestational cardiovascular health have been significantly associated with adverse pregnancy outcomes.

They categorized cardiovascular health for offspring at age 10 to 14 years based on four of these five metrics: body mass index, blood pressure, cholesterol, and glucose.

Only 32.8% of mothers and 42.2% of children had ideal cardiovascular health.

In analyses adjusted for pregnancy and birth outcomes, the associations seen between poor gestational maternal health and offspring cardiovascular health persisted but were attenuated.

Perak reported receiving grants from the Woman's Board of Northwestern Memorial Hospital, The Dixon Family, the American Heart Association, and the National Heart, Lung, and Blood Institute. Daniels reported no conflicts of interest.

JAMA. 2021;325:658-668, 630-631. Abstract, Editorial

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