Hypertensive Disorders of Pregnancy and Offspring Cardiometabolic Health at Midchildhood: Project Viva Findings

Abstract

Background: Exposure to preeclampsia or gestational hypertension is associated with higher offspring systolic blood pressure (SBP), but less is known about associations with other cardiometabolic risk markers.

Methods and results: We studied 1097 children from the Project Viva cohort born 1999-2002. Exposures were preeclampsia or gestational hypertension and mean maternal SBP in each trimester from prenatal records. Outcomes were research measures in midchildhood (mean 8.0 years) of SBP, overall adiposity, and a global cardiometabolic risk score comprising measures of SBP, waist circumference, glycemia, and lipids. We conducted linear regression analyses adjusted for maternal characteristics and offspring sex and age. In adjusted models, maternal preeclampsia or gestational hypertension (n=98, 9.1%) versus normal blood pressure was associated with slightly higher offspring SBP z-score (0.15 units; 95% confidence interval [CI] -0.03, 0.32) but otherwise predicted better cardiometabolic health markers including metabolic risk z-score (-0.23 units; -95% CI 0.44, -0.03) and several of its components as well as lower body mass index z-score (-0.27 units; 95% CI -0.48, -0.06) and lower fat mass index (-0.91 kg/m²; 95% CI -1.35, -0.47). Similarly, higher mean third-trimester maternal SBP was associated with higher offspring SBP z-score (0.09 units per 10 mm Hg; 95% CI 0.02, 0.16) and lower overall and central adiposity but not with biomarkers of metabolic risk. Results for second-trimester SBP were generally similar. First-trimester blood pressure was associated with higher offspring blood pressure but not with other outcomes.

Conclusions: Higher maternal late-pregnancy SBP and hypertensive disorders of pregnancy were associated with higher offspring SBP but otherwise better cardiometabolic health.

Keywords: high blood pressure; hypertension; preeclampsia/pregnancy.

Figure 1

Associations of preeclampsia (PE) or gestational hypertension (GH) in pregnancy, vs normal maternal blood pressure, with selected offspring cardiometabolic outcomes in midchildhood among 1097 children in the Project Viva cohort. Data points are β coefficients (with error bars displaying 95% confidence intervals) from multivariable linear regression models adjusted for child age at outcome and sex (except SBP z‐score and BMI z‐score, which already account for age and sex), and maternal race/ethnicity, age at enrollment, height, prepregnancy BMI, education, household income, parity, and smoking during pregnancy. Circles are plotted on the primary Y axis (left side), and squares on the secondary Y axis (right side). BMI indicates body mass index; DXA, dual x‐ray absorptiometry; GH, gestational hypertension; HDL, high‐density lipoprotein; HOMA‐IR, homeostatic models assessment of insulin resistance; PE, preeclampsia; SBP, systolic blood pressure.