Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence

Abstract

Importance: Pregnancy may be a key window to optimize cardiovascular health (CVH) for the mother and influence lifelong CVH for her child.

Objective: To examine associations between maternal gestational CVH and offspring CVH.

Design, setting, and participants: This cohort study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study (examinations: July 2000-April 2006) and HAPO Follow-Up Study (examinations: February 2013-December 2016). The analyses included 2302 mother-child dyads, comprising 48% of HAPO Follow-Up Study participants, in an ancillary CVH study. Participants were from 9 field centers across the United States, Barbados, United Kingdom, China, Thailand, and Canada.

Exposures: Maternal gestational CVH at a target of 28 weeks' gestation, based on 5 metrics: body mass index, blood pressure, total cholesterol level, glucose level, and smoking. Each metric was categorized as ideal, intermediate, or poor using pregnancy guidelines. Total CVH was categorized as follows: all ideal metrics, 1 or more intermediate (but 0 poor) metrics, 1 poor metric, or 2 or more poor metrics.

Main outcomes and measures: Offspring CVH at ages 10 to 14 years, based on 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Total CVH was categorized as for mothers.

Results: Among 2302 dyads, the mean (SD) ages were 29.6 (2.7) years for pregnant mothers and 11.3 (1.1) years for children. During pregnancy, the mean (SD) maternal CVH score was 8.6 (1.4) out of 10. Among pregnant mothers, the prevalence of all ideal metrics was 32.8% (95% CI, 30.6%-35.1%), 31.7% (95% CI, 29.4%-34.0%) for 1 or more intermediate metrics, 29.5% (95% CI, 27.2%-31.7%) for 1 poor metric, and 6.0% (95% CI, 3.8%-8.3%) for 2 or more poor metrics. Among children of mothers with all ideal metrics, the prevalence of all ideal metrics was 42.2% (95% CI, 38.4%-46.2%), 36.7% (95% CI, 32.9%-40.7%) for 1 or more intermediate metrics, 18.4% (95% CI, 14.6%-22.4%) for 1 poor metric, and 2.6% (95% CI, 0%-6.6%) for 2 or more poor metrics. Among children of mothers with 2 or more poor metrics, the prevalence of all ideal metrics was 30.7% (95% CI, 22.0%-40.4%), 28.3% (95% CI, 19.7%-38.1%) for 1 or more intermediate metrics, 30.7% (95% CI, 22.0%-40.4%) for 1 poor metric, and 10.2% (95% CI, 1.6%-20.0%) for 2 or more poor metrics. The adjusted relative risks associated with 1 or more intermediate, 1 poor, and 2 or more poor (vs all ideal) metrics, respectively, in mothers during pregnancy were 1.17 (95% CI, 0.96-1.42), 1.66 (95% CI, 1.39-1.99), and 2.02 (95% CI, 1.55-2.64) for offspring to have 1 poor (vs all ideal) metrics, and the relative risks were 2.15 (95% CI, 1.23-3.75), 3.32 (95% CI,1.96-5.62), and 7.82 (95% CI, 4.12-14.85) for offspring to have 2 or more poor (vs all ideal) metrics. Additional adjustment for categorical birth factors (eg, preeclampsia) did not fully explain these significant associations (eg, relative risk for association between 2 or more poor metrics among mothers during pregnancy and 2 or more poor metrics among offspring after adjustment for an extended set of birth factors, 6.23 [95% CI, 3.03-12.82]).

Conclusions and relevance: In this multinational cohort, better maternal CVH at 28 weeks' gestation was significantly associated with better offspring CVH at ages 10 to 14 years.

Figure 1.. Frequencies of Offspring Cardiovascular Health (CVH) Statuses by Maternal Gestational CVH Status (N = 2302)

Absolute frequencies of maternal-offspring CVH combinations are indicated by the numerals and shading within the cells, and in panel B, corresponding percentages (with 95% CIs) are also shown within the cells. The frequencies and percentages of maternal and offspring CVH statuses within the total study sample are shown separately below and to the right of the heatmaps. In panel A, CVH scores lower than 2 were not observed for mothers or children and are not shown (n = 2170). In panel B, trend P values for differences in the distribution of offspring CVH categories between maternal gestational CVH categories were as follows: all ideal (vs any nonideal) gestational CVH metrics, <.001; 1 or more intermediate, but 0 poor (vs all ideal), metrics, .10; 1 poor (vs all ideal) metrics, <.001; and 2 or more poor (vs all ideal) metrics, <.001 (n = 2174).

Figure 2.. Adjusted Associations of Maternal Gestational Cardiovascular Health (CVH) With Offspring CVH in Childhood

Associations of maternal gestational CVH score and categories with offspring CVH score (A) and category (B) in childhood are shown. All estimates were adjusted for field center (each with a high level of demographic homogeneity), child sex and age at follow-up, and variables during the pregnancy examination, including age, height, parity, alcohol use, and gestational age (ie, model 2). The error bars indicate 95% CIs. For the maternal CVH category exposures, the P values shown are global P values from a 3-df omnibus test comparing the log likelihood of the model with the 4-level categorical maternal CVH variable vs that without it for each child outcome. The CVH score has a possible range of 0 to 10 points for pregnant mothers (observed range, 2-10 points) and 0 to 8 points for children (observed range, 2-8 points). The numbers of mother-child dyads in each combination of CVH scores and categories appear in Figure 1. Additional details appear in eTable 2 in the Supplement. ^aGlobal P value.

Figure 3.. Heatmap of Adjusted Associations Between Individual Metrics of Maternal Gestational Cardiovascular Health (CVH) and Offspring CVH

The heatmaps are shaded according to the adjusted relative risks (RRs) for associations between maternal gestational CVH metrics (A and C) or categories (B) and offspring childhood CVH metrics (B and C) or categories (A). Adjusted RR estimates (with 95% CIs) and sample sizes are shown within the cells. All estimates were adjusted for field center (each with a high level of demographic homogeneity); child sex and age at follow-up; maternal variables during the pregnancy examination, including age, height, parity, alcohol use, and gestational age, as well as levels (ideal vs nonideal [intermediate/poor]) of each of the other 4 gestational CVH metrics (except when total gestational CVH is the exposure). Additional details appear in eTable 3 in the Supplement.