Mom’s CV Health in Pregnancy Foretells Child’s Risk Years Later
The findings put a spotlight on the need for primordial prevention, rather than tackling problems after they manifest.
A pregnant woman’s heart health may have a direct impact on what her child's CV health will look like as early as adolescence, according to new findings.
Researchers found that only 32.8% of the pregnant women they studied met all optimal gestational metrics for body mass index (BMI), blood pressure, total cholesterol level, glucose level, and smoking status. Similarly, only 37.3% of their children met all the metrics for ideal CV health for their age. Children born to those with the poorest metrics were found to have almost eight times higher risk for poor CV health themselves by the time they were ages 10 to 14.
“Having poor cardiovascular health at such a young age, we know from other work, is associated with increased risk for cardiovascular disease events and mortality fairly young in adulthood,” Amanda M. Perak, MD, MS (Northwestern University Feinberg School of Medicine, Chicago, IL), the study’s lead author, told TCTMD. “The mom's cardiovascular health levels during pregnancy need to be investigated a little bit further to see if improving them could help their kids avoid cardiovascular disease in the long run.” The study was published is the February 16, 2021, issue of JAMA.
The findings set the stage for further investigation into the merits of primordial prevention, agrees Stephen R. Daniels, MD, PhD (University of Colorado School of Medicine, Aurora), in an accompanying editorial. Primordial prevention advocates maintain that the ideal state of CV health that most people have at birth theoretically puts them at low risk of developing atherosclerosis as long as they maintain it throughout their life. Thus, “the focus should be on maintaining optimum or favorable cardiovascular health, including prevention of the development of risk factors,” rather than tackling them after they develop, Daniels notes.
Perak, who is a pediatric preventive cardiologist, said based on the number of children she sees with obesity, hypertension, and hypercholesterolemia before age 12, more attention to the importance of maintaining good CV health during a woman’s reproductive years is needed, as is early identification of children at risk. The findings build on a prior study by Perak and colleagues of pregnant women in their 20s, 30s, and 40s, which found that more than 90% had suboptimal cardiovascular health.
Clear Mother-Child Health Connections
The new study consisted of a multinational cohort of 2,302 mother-child pairs from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. Cardiovascular health in children was measured by BMI, blood pressure, total cholesterol level. and glucose level.
The mean CV health score for women at 28 weeks’ gestation was 8.6 out of a possible 10. For the children, who were between the ages of 10 and 14 at the time of the study, the mean CV health score was 6.8 out of a possible 8.
When the researchers looked at each gestational metric separately, all (except for smoking) were independently and significantly associated with the adolescent CV health of their child. Metrics were classified as ideal, intermediate, or poor. An increasing number of intermediate or poor metrics was associated with higher relative risks of poor adolescent CV health in the children. Of the total cohort, 6% of mothers and 2.6% of children had two or more metrics classified as poor. Compared with having all ideal metrics, having two or more poor metrics resulted in a relative risk of poor adolescent CV health in the child of 7.82 (95% CI 4.12-14.85) versus 2.02 (95% CI 1.55-2.64) for one or more poor metric.
While Daniels says the findings “support the concept that fetal life may be a critical period for subsequent cardiovascular health and that the mother’s cardiovascular health status during pregnancy may have a long-term influence on the cardiovascular health of her offspring,” they also show that not everyone is born with the same “clean slate” that the primordial prevention concept initially envisioned. Furthermore, Daniels says the study raises important questions, including the best way to define optimum CV health during pregnancy.
“Pregnancy is a time of rapidly changing weight, hemodynamic status, blood glucose level, blood lipid levels, and other factors,” he writes. “It is difficult to know how to determine cut points for these variables that indicate cardiovascular health. It is also not clear at which gestational age it would be most valuable to ascertain cardiovascular health status.” He further notes that the study authors did not have access to diet or physical activity information on the mothers during pregnancy or knowledge of their CV health at the time their children were adolescents.
“This information could provide some indication of lifestyle factors in the family after birth and into childhood and adolescence,” Daniels notes. “In addition, the mechanisms by which maternal cardiovascular health could affect offspring later in life remain unknown and may involve biological effects, shared lifestyle, and common genetic factors.”
To TCTMD, Perak said one of the takeaway messages of the study is that current systems of prenatal care and pre-conception counseling can be improved upon and should be studied further despite concerns that it might add to tight time lines that physicians balance in office visits. One example, she said, might be a randomized controlled trial in which half the group is assigned to an aggressive intervention to optimize CV health that includes resources and counseling and goes beyond standard advice about maintaining healthy weight and not giving in to pregnancy-related food cravings.
“If we saw that that indeed improved the mom's health during pregnancy and that led to improved health for the baby, then I think we could talk about making room for it in short prenatal visits. I'm a believer in it,” she added.
Perak AM, Lancki N, Kuang A, et al. Associations of maternal cardiovascular health in pregnancy with offspring cardiovascular health in early adolescence. JAMA. 2021;325:658-668.
Daniels SR. Maternal cardiovascular health: a critical period for offspring lifetime cardiovascular health? JAMA. 2021;325:630-631.
- Perak reports grants from the Woman’s Board of Northwestern Memorial Hospital, the Dixon Translational Research Grants Initiative, and the American Heart Association during the conduct of the study, and grants from the National Institutes of Health/National Heart, Lung, and Blood Institute outside the submitted work.
- Daniels reports no relevant conflicts of interest.