Early-Life Predictors of Systolic Blood Pressure Trajectories From Infancy to Adolescence: Findings From Project Viva

Abstract

Childhood blood pressure (BP) is a strong predictor of later risk of cardiovascular disease. However, few studies have assessed dynamic BP trajectories throughout the early-life period. We investigated the relationship between early-life factors and systolic BP (SBP) from infancy to adolescence using linear spline mixed-effects models among 1,370 children from Project Viva, a Boston, Massachusetts-area cohort recruited in 1999-2002. After adjusting for confounders and child height, we observed higher SBP in children exposed to gestational diabetes mellitus (vs. normoglycemia; age 3 years: β = 3.16 mm Hg (95% confidence interval (CI): 0.28, 6.04); age 6 years: β = 1.83 mm Hg (95% CI: 0.06, 3.60)), hypertensive disorders of pregnancy (vs. normal maternal BP; age 6 years: β = 1.39 mm Hg (95% CI: 0.10, 2.67); age 9 years: β = 1.84 mm Hg (95% CI: 0.34, 3.34); age 12 years: β = 1.70 mm Hg (95% CI: 0.48, 2.92)), higher neonatal SBP (per 10-mm Hg increase; age 3 years: β = 1.26 mm Hg (95% CI: 0.42, 2.09); age 6 years: β = 1.00 mm Hg (95% CI: 0.49, 1.51); age 9 years: β = 0.75 mm Hg (95% CI: 0.17, 1.33)), and formula milk in the first 6 months of life (vs. breast milk only; age 12 years: β = 2.10 mm Hg (95% CI: 0.46, 3.74); age 15 years: β = 3.52 mm Hg (95% CI: 1.40, 5.64); age 18 years: β = 4.94 mm Hg (95% CI: 1.88, 7.99)). Our findings provide evidence of programming of offspring SBP trajectories by gestational diabetes, hypertensive disorders of pregnancy, and formula milk intake and of neonatal BP being a potentially useful marker of childhood BP. These factors could be relevant in identifying children who are at risk of developing elevated BP.

Keywords: blood pressure; blood pressure trajectory; developmental programming; pregnancy; risk factors; systolic blood pressure.

Figure 1.

Predicted trajectories of child systolic blood pressure (BP) from ages 6 months to 18 years according to maternal prepregnancy body mass index (BMI; weight (kg)/height (m)²) (A), smoking history (B), hypertensive disorders of pregnancy (C), and glucose tolerance status (D) among participants recruited into Project Viva in 1999–2002, Boston, Massachusetts. The models adjusted for type of study visit, all prenatal factors, and child height z score. GDM, gestational diabetes mellitus; GH, gestational hypertension; IGT, impaired glucose tolerance.

Figure 2.

Predicted trajectories of child systolic blood pressure (BP) from ages 6 months to 18 years according to child birth weight for gestational age (BW-for-GA) (A), neonatal BP (B), infant feeding type in the first 6 months of life (C), and infancy gain in age- and sex-specific body mass index (BMI; weight (kg)/height (m)²) z score (zBMI) (D) among participants recruited into Project Viva in 1999–2002, Boston, Massachusetts. Models for BW-for-GA and neonatal BP adjusted for prenatal factors; models for infant feeding type and infancy zBMI gain adjusted for prenatal and perinatal factors. All models additionally adjusted for type of study visit and child height z score. SD, standard deviation.