Researchers have discovered that three common maternal cardiometabolic conditions during pregnancy significantly increase the risk of elevated blood pressure in children, potentially setting them up for cardiovascular issues later in life.
A comprehensive study published in JAMA Network Open found that maternal prepregnancy obesity, gestational diabetes, and hypertensive disorders of pregnancy (HDP) were associated with higher blood pressure measurements in offspring that persist and worsen throughout childhood and adolescence.
Key Findings on Blood Pressure Impact
The cohort study, which analyzed data from more than 12,000 mother-offspring pairs across the United States, revealed that children born to mothers with at least one of these risk factors had a 4.88–percentile point higher systolic blood pressure and a 1.90–percentile point higher diastolic blood pressure at their first measurement compared to children of mothers without these conditions.
"These findings suggest that protecting pregnant individuals from cardiometabolic risk factors may promote healthier blood pressure in the next generation," the study authors noted.
Among the maternal risk factors, hypertensive disorders of pregnancy showed the strongest association with elevated offspring blood pressure, both independently and when combined with other risk factors. The most significant increase in systolic blood pressure occurred in children whose mothers had both HDP and prepregnancy obesity (adjusted β, 7.31; 95% CI, 4.99-9.62).
Demographic Disparities in Risk
The research revealed concerning disparities in how these maternal risk factors affect different demographic groups. Female offspring showed a stronger association between maternal risk factors and elevated blood pressure compared to males.
Even more concerning were the racial disparities observed. Black children demonstrated higher susceptibility to elevated blood pressure when their mothers had gestational diabetes or hypertensive disorders during pregnancy. Compared to White offspring, Black offspring had significantly higher systolic blood pressure if their mother had gestational diabetes (adjusted β, 7.60 vs 0.63; P for interaction = .01) or HDP (adjusted β, 7.48 vs 3.42; P for interaction = .01).
"This is especially concerning as Black women are already known to be at a disproportionate risk for several conditions such as cardiovascular disease, hypertension, obesity, diabetes, and certain cancers," explained lead researcher Zhongzheng (Jason) Niu, an assistant professor of epidemiology and environmental health at the University at Buffalo.
Long-Term Implications for Children
The study also tracked blood pressure changes over time in 6,015 offspring who had multiple measurements. Children of mothers with cardiometabolic risk factors showed an accelerated rate of blood pressure increase from ages 2 to 18 years, with a 0.5 percentile annual increase in systolic blood pressure and a 0.7 percentile annual increase in diastolic blood pressure.
"Our evidence is clear, showing that even a small blood pressure difference in early life can magnify over a longer period," said Niu. "Currently, most clinical guidelines do not suggest blood pressure screenings for children who seem healthy overall."
Prevalence of Maternal Risk Factors
The study found that nearly half (44%) of the mothers presented with at least one cardiometabolic risk factor during pregnancy. Prepregnancy obesity was the most prevalent, affecting approximately 25% of pregnant mothers, followed by hypertensive disorders (13.6%) and gestational diabetes (6.5%).
The mean maternal age at pregnancy was 29.9 years, and the study population was diverse, with 52% identifying as White, 19% as Hispanic, 16% as Black, 7% as Asian, and 6% as another race or ethnicity.
Potential Mechanisms and Implications
The researchers noted that the associations between maternal cardiometabolic risk factors and high offspring blood pressure appeared to be independent of familial and individual adiposity, suggesting a possible direct programming effect from intrauterine exposure.
"If such a programming effect is causal, achieving a healthier cardiometabolic profile in the childbearing population would be essential to improve cardiovascular health in future generations," the authors stated.
Senior researcher Shohreh Farzan, an associate professor of population and public health sciences at the University of Southern California's Keck School of Medicine, emphasized the importance of early intervention: "Finding factors that we can address during pregnancy and childhood — and implementing early interventions — may be key to changing the trajectories of health for future generations."
Study Limitations and Future Research
While the study had significant strengths, including its large, diverse population and longitudinal design, the researchers acknowledged several limitations. They did not differentiate between subtypes of hypertensive disorders of pregnancy, which might have varying effects on offspring blood pressure. Additionally, they relied on body mass index to define prepregnancy obesity without data on gestational weight gain, diet, or physical activity.
These findings highlight the need for increased attention to maternal health during pregnancy as a potential strategy for preventing cardiovascular disease across generations. They also suggest that children born to mothers with these risk factors might benefit from earlier and more frequent blood pressure monitoring, even in the absence of other health concerns.
