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Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence

Educational Objective
To understand the association of cardiovascular health in pregnant women and their offspring.
1 Credit CME
Key Points

Question  Is maternal cardiovascular health during pregnancy (characterized by the combination of 5 metrics: body mass index, blood pressure, total cholesterol level, glucose level, and smoking) associated with offspring cardiovascular health during early adolescence (characterized by the combination of 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level)?

Findings  In this multinational cohort study of 2302 mother-child dyads, poorer maternal cardiovascular health at a mean of 28 weeks’ gestation was significantly associated with higher risks for poorer offspring cardiovascular health at ages 10 to 14 years (adjusted relative risk for association between ≥2 poor [vs all ideal] maternal metrics and ≥2 poor [vs all ideal] offspring metrics, 7.82).

Meaning  Maternal cardiovascular health during pregnancy was significantly associated with offspring cardiovascular health during 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. Among pregnant mothers, the prevalence of all ideal metrics was 32.8% (95% CI, 30.6%-35.1%), 31.7% (95% CI, 29.4%-34.0%) for 1 or more intermediate metrics, 29.5% (95% CI, 27.2%-31.7%) for 1 poor metric, and 6.0% (95% CI, 3.8%-8.3%) for 2 or more poor metrics. Among children of mothers with all ideal metrics, the prevalence of all ideal metrics was 42.2% (95% CI, 38.4%-46.2%), 36.7% (95% CI, 32.9%-40.7%) for 1 or more intermediate metrics, 18.4% (95% CI, 14.6%-22.4%) for 1 poor metric, and 2.6% (95% CI, 0%-6.6%) for 2 or more poor metrics. Among children of mothers with 2 or more poor metrics, the prevalence of all ideal metrics was 30.7% (95% CI, 22.0%-40.4%), 28.3% (95% CI, 19.7%-38.1%) for 1 or more intermediate metrics, 30.7% (95% CI, 22.0%-40.4%) for 1 poor metric, and 10.2% (95% CI, 1.6%-20.0%) for 2 or more poor metrics. The adjusted relative risks associated with 1 or more intermediate, 1 poor, and 2 or more poor (vs all ideal) metrics, respectively, in mothers during pregnancy were 1.17 (95% CI, 0.96-1.42), 1.66 (95% CI, 1.39-1.99), and 2.02 (95% CI, 1.55-2.64) for offspring to have 1 poor (vs all ideal) metrics, and the relative risks were 2.15 (95% CI, 1.23-3.75), 3.32 (95% CI,1.96-5.62), and 7.82 (95% CI, 4.12-14.85) for offspring to have 2 or more poor (vs all ideal) metrics. 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.

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Article Information

Corresponding Author: Amanda M. Perak, MD, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Ste 1400, Chicago, IL 60611 (amarma@luriechildrens.org).

Accepted for Publication: January 10, 2021.

Author Contributions: Dr Perak and Ms Lancki had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Lowe and Scholtens contributed equally.

Concept and design: Perak, Shah, Lowe, Lloyd-Jones, Lowe Jr, Scholtens.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Perak, Lancki, Lowe, Lloyd-Jones, Scholtens.

Critical revision of the manuscript for important intellectual content: Perak, Kuang, Labarthe, Allen, Shah, Grobman, Lawrence, Lloyd-Jones, Lowe Jr, Scholtens.

Statistical analysis: Lancki, Kuang, Shah, Scholtens.

Obtained funding: Perak, Lloyd-Jones, Lowe Jr.

Administrative, technical, or material support: Labarthe, Lowe.

Supervision: Perak, Lloyd-Jones, Lowe Jr, Scholtens.

Conflict of Interest Disclosures: Dr Perak reported receiving grants from the Woman’s Board of Northwestern Memorial Hospital (Eleanor Wood-Prince Grant), the Dixon Family (Dixon Translational Research Grants Initiative), and the American Heart Association (17SFRN33660752) during the conduct of the study and grants from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (K23HL145101) outside the submitted work. Dr Shah reported receiving grants from AstraZeneca, Eli Lilly and Company, and Verily Life Sciences outside the submitted work. Dr Lowe reported receiving grants from the NIH during the conduct of the study. Dr Lloyd-Jones reported receiving grants from the NIH during the conduct of the study. Dr Lowe Jr reported serving as co-investigator on a grant from the NIH that supported the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-Up Study (FUS) (grant U01DK94830) and principal investigator of 2 additional NIH grants, which provided some of the data used in these analyses (grant R01DK095963: “Maternal Obesity and Gestational Diabetes: Impact on Metabolome” and R01DK117491: “Predicting Newborn and Childhood Adiposity: An Integrated Omics Approach”). Dr Scholtens reported receiving grants from the NIH to support the HAPO study during the conduct of the study. No other disclosures were reported.

Funding/Support: The HAPO Study was funded by grants R01HD34242 and R01HD34243 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with additional HAPO ancillary study data obtained through grants R01DK095963 and R01DK117491 from the National Institute of Diabetes and Digestive and Kidney Diseases. The HAPO Follow-Up Study was funded by grant 1U01DK094830 from the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The ancillary cardiovascular health study was funded by a Dixon Translational Research Grant from the Northwestern University Clinical and Translational Sciences Institute and the Northwestern Memorial Foundation, an Eleanor Wood-Prince Grant from the Woman’s Board of Northwestern Memorial Hospital, and a subcontract under grant 17SFRN33660752 from the American Heart Association. The research reported in this article was supported, in part, by grant UL1TR001422 from the National Center for Advancing Translational Sciences, NIH. Dr Perak’s work was supported by grant K23HL145101 from the National Heart, Lung, and Blood Institute and a Pediatric Physician-Scientist Research Award from the Northwestern University Feinberg School of Medicine Department of Pediatrics. The authors’ work was also supported in part by grants 17SFRN33660752 (Dr Labarthe), 17SFRN33700101 (Drs Labarthe, Allen, and Lloyd-Jones), and 17SFRN33700155 (Dr Shah) from the American Heart Association.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: Members of the HAPO FUS Cooperative Research Group are listed in the eAppendix in the Supplement.

Disclaimer: Denise M. Scholtens is a statistical reviewer of JAMA, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Meeting Presentation: Preliminary findings were presented at the American Heart Association’s Scientific Sessions 2019; November 18, 2019; Philadelphia, Pennsylvania.

Additional Contributions: We gratefully acknowledge the mothers and children who participated in HAPO and HAPO FUS.

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