Summary: Children whose mothers had obesity, gestational diabetes, or hypertensive disorders during pregnancy show higher blood pressure from early childhood through adolescence. These offspring also experience faster increases in blood pressure between ages 2 and 18, indicating lasting cardiovascular effects of prenatal exposures.
Based on nearly three decades of data from more than 12,000 mother–child pairs, the study highlights how maternal cardiometabolic health before and during pregnancy can shape a child’s blood pressure trajectory. The results support earlier prevention efforts, including improving maternal health in the childbearing years and considering routine blood pressure screening for children with prenatal risk exposures.
Key Facts:
- Prenatal Risk Impact: Offspring of mothers with at least one cardiometabolic risk factor—prepregnancy obesity, gestational diabetes, or hypertensive disorders of pregnancy—had higher systolic and diastolic blood pressure percentiles than peers without those exposures.
- Faster BP Growth: Blood pressure rose more quickly from ages 2 to 18 in children exposed to maternal cardiometabolic risk factors.
- Disparities Observed: Associations were stronger in girls and in Black children, suggesting complex interactions between biological and social determinants of health.
Source: USC
Overview
A new study from the Keck School of Medicine of USC found that children born to mothers with obesity, gestational diabetes mellitus, or hypertensive disorders of pregnancy had higher systolic and diastolic blood pressure than children born to mothers without those conditions. The analysis also showed that blood pressure increased faster across childhood and adolescence for those exposed in utero.
The peer-reviewed findings, suggesting that blood pressure prevention strategies might begin as early as pregnancy, were published in JAMA Network Open.
With cardiovascular health declining nationally and hypertension appearing earlier in life, researchers are focused on how early development—beginning before birth—affects later blood pressure. Until now, many studies examined maternal risk factors individually; this USC team evaluated how common cardiometabolic exposures interact and combine to influence offspring blood pressure from ages 2 to 18.
The study drew on data from the Environmental influences on Child Health Outcomes (ECHO) Program, covering January 1994 through March 2023 and including 12,480 mother–child pairs from across the United States.
“There is still much to learn about preventing cardiovascular disease across the life course,” said Shohreh Farzan, PhD, associate professor of population and public health sciences at the Keck School of Medicine and the study’s senior author. “Addressing modifiable factors during pregnancy and early childhood could change health trajectories for future generations.”
Funded by the National Institutes of Health, the analysis found that children whose mothers had at least one cardiometabolic risk factor averaged 4.88 percentile points higher in systolic blood pressure (SBP) and 1.90 percentile points higher in diastolic blood pressure (DBP) than children whose mothers had no such factors. Those exposed to multiple maternal risk factors, such as both obesity and a hypertensive disorder of pregnancy, showed even larger differences.
The study’s first author, Zhongzheng (Jason) Niu, PhD, noted that the results support prevention on two fronts: improving cardiovascular health for people before and during pregnancy and implementing earlier blood pressure screening for children who were exposed to maternal cardiometabolic risks.
Blood pressure percentiles and study design
Researchers harmonized demographic and clinical data from ECHO sites to calculate SBP and DBP percentiles for children, adjusting measures for age, sex, and height. About half of participants identified as non-white. Nearly 44.4% of mothers (5,537 women) had at least one cardiometabolic risk factor: prepregnancy obesity was most common (3,072 mothers, 24.6%), followed by hypertensive disorders of pregnancy (1,693 mothers, 13.6%) and gestational diabetes (805 mothers, 6.5%).
Analyses adjusted for potential confounders including maternal age, race and ethnicity, education, income, parity, and smoking during pregnancy, so the associations reflect links between maternal cardiometabolic status and offspring blood pressure independent of these factors.
Findings on elevated blood pressure and growth over time
At the first recorded blood pressure measurement, children exposed to any maternal cardiometabolic risk factor were higher in SBP percentile by an average of 4.88 points and higher in DBP percentile by an average of 1.09 points compared with peers whose mothers had no risk factors. When mothers had two risk factors, the elevations were larger—for example, children of mothers with both obesity and a hypertensive disorder had SBP percentiles 7.31 points higher and DBP percentiles 4.04 points higher on average.
The associations were generally stronger for female offspring than male offspring and stronger among Black children compared with other racial and ethnic groups. Among 6,015 children with two or more blood pressure readings, the rate of increase from ages 2 to 18 was higher for those born to mothers with at least one risk factor: SBP rose by about 0.5 percentile points per year and DBP by about 0.7 percentile points per year more than children born to mothers without risk factors.
Implications for screening and prevention
The study suggests that protecting people from cardiometabolic conditions before and during pregnancy could yield cardiovascular benefits for the next generation. Earlier and targeted blood pressure screening for children with prenatal exposures could help identify at-risk youth before clinical problems develop, since small differences in early life blood pressure can grow over time.
Farzan, Niu, and colleagues are continuing to investigate how combinations of social and environmental factors—such as air pollution and stress—interact with maternal cardiometabolic health to shape child cardiovascular outcomes.
About this research
Study authors include Shohreh Farzan and Zhongzheng (Jason) Niu, along with researchers from the Keck School of Medicine of USC and numerous collaborating institutions across the United States. The research was supported by the National Institutes of Health ECHO program [UH3OD023287].
About this cardiovascular health research news
Author: Laura LeBlanc
Source: USC
Contact: Laura LeBlanc – USC
Image: The image is credited to Neuroscience News
Original Research: Open access. “Maternal Cardiometabolic Risk Factors in Pregnancy and Offspring Blood Pressure at Age 2 to 18 years” by Shohreh Farzan, et al. JAMA Network Open
Abstract
Maternal Cardiometabolic Risk Factors in Pregnancy and Offspring Blood Pressure at Age 2 to 18 years
Importance
Higher blood pressure in early life can indicate increased lifetime cardiovascular risk, but the early-life determinants of blood pressure are not fully understood.
Objective
To evaluate associations between maternal cardiometabolic risk factors during pregnancy—prepregnancy obesity, gestational diabetes, and hypertensive disorders of pregnancy—and offspring blood pressure percentiles from age 2 through 18, and to examine whether associations differ by offspring sex and race/ethnicity.
Design, Setting, and Participants
This cohort study analyzed ECHO Program data collected from January 1, 1994, to March 31, 2023. Maternal cardiometabolic exposures were harmonized from medical records and questionnaires; offspring SBP and DBP percentiles were calculated accounting for age, sex, and height.
Results
Among 12,480 mother–child pairs (mean maternal age 29.9 years), 44.4% of mothers had at least one cardiometabolic risk factor, with prepregnancy obesity most common (24.6%), followed by hypertensive disorders of pregnancy (13.6%) and gestational diabetes (6.5%). Offspring of mothers with any cardiometabolic risk factor had higher SBP (4.88 percentile points) and DBP (1.90 percentile points) at first measurement compared with those whose mothers had no risk factors. Hypertensive disorders of pregnancy, alone or combined with other risk factors, showed particularly strong associations. Associations were generally stronger for female offspring and for Black children. Among 6,015 children with multiple blood pressure readings, maternal risk factors were associated with faster increases in SBP (0.5 percentile points per year) and DBP (0.7 percentile points per year) from ages 2 to 18.
Conclusions and Relevance
The findings indicate that reducing maternal cardiometabolic risk before and during pregnancy may contribute to healthier blood pressure profiles in children and adolescents, supporting prevention efforts that span from preconception through childhood.
Funding: This work was supported by the National Institutes of Health Environmental influences on Child Health Outcomes program [UH3OD023287].