A recent study from the Environmental influences on Child Health Outcomes (ECHO) project has found that children born to mothers with cardiometabolic risk factors during pregnancy—such as hypertensive disorders of pregnancy (HDP), gestational diabetes, or pre-pregnancy diabetes—are more likely to have higher blood pressure in early childhood.
Dr. Zhongzheng Niu of the University of Southern California, lead author of the study, told TCTMD that this research builds on previous findings by analyzing a large cohort of over 12,000 mother-child pairs. The scale of the data enabled the team to examine the effects of each cardiometabolic risk factor individually and in combination.
“Our key finding is that children born to mothers with multiple cardiometabolic risk factors show higher blood pressure than those born to mothers without such risks or with only one risk factor,” Dr. Niu said.
Notably, the study included blood pressure measurements of children as young as two years old, unlike most previous studies that focused on children aged eight to seventeen. The researchers also tracked changes in blood pressure over time.
Dr. Shohreh F. Farzan, a senior author from USC, emphasized the broad clinical implications of the findings. “Promoting the health of women of reproductive age is crucial, as addressing maternal risk factors can benefit subsequent generations. From a pediatric perspective, screening children born to at-risk mothers and considering early interventions where necessary is meaningful,” Farzan explained.
Blood pressure in children tends to increase steadily with age, and even small early differences may become more significant over time. “Our study highlights the importance of addressing both maternal and child health simultaneously,” Farzan added.
The study analyzed data from 12,480 mother-child pairs drawn from 69 cohorts across the United States, spanning births from 1994 to 2023. Among the mothers, 44.4% had at least one cardiometabolic risk factor, including 24.6% with pre-pregnancy obesity, 13.6% with hypertensive disorders of pregnancy, and 6.5% with gestational diabetes. The cohort was racially and ethnically diverse.
Blood pressure readings were adjusted for the child’s age, height, sex, as well as maternal factors such as age, race/ethnicity, education, income, marital status, parity, and smoking during pregnancy.
Compared to children of mothers without these risk factors, offspring of mothers with any one risk factor had higher systolic and diastolic blood pressure between ages two and five. The only exception was no significant association between gestational diabetes and diastolic blood pressure.
The greatest increase in systolic blood pressure was observed in children born to mothers with both hypertensive disorders of pregnancy and pre-pregnancy obesity, followed by those with hypertensive disorders and gestational diabetes. For diastolic blood pressure, the largest changes were seen in children of mothers with hypertensive disorders and gestational diabetes, followed by those with hypertensive disorders and pre-pregnancy obesity.
Although only 0.9% of participants had all three cardiometabolic risk factors simultaneously, the trend toward increased blood pressure was evident. The associations were strongest in female and Black children.
Dr. Niu noted that a 4.88 percentile point increase in blood pressure places children near the threshold between elevated blood pressure and pediatric hypertension, making these findings clinically relevant.
Longitudinal analysis showed that the impact of maternal cardiometabolic health on offspring blood pressure accelerated from ages two to eighteen, increasing by approximately 0.5 to 0.7 percentile points per year.
Dr. Farzan stated, “Children set on a higher blood pressure trajectory early in life may remain at elevated risk as they age.”
The researchers suggest that the combination of maternal obesity with hypertensive disorders or gestational diabetes may have additive effects on offspring blood pressure, potentially due to mechanisms involving placental-fetal circulation disruption, insulin resistance, and endothelial dysfunction.
Commentators Jennifer H. Klein, MD, MPH, and Michele Mietus-Snyder, MD, from Children’s National Hospital, Washington DC, noted that while these findings are not entirely new, they add significant evidence supporting the role of the intrauterine environment in lifelong health. They highlighted epigenetics as a potential explanation, whereby environmental factors influence gene expression across generations.
The commentators emphasized the importance of focusing on maternal and early neonatal health as a critical window for primordial prevention.
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