Maternal overnutrition elevates offspring's blood pressure-A systematic review and meta-analysis

Abstract

Background: Maternal overnutrition during pregnancy predisposes the offspring to cardiometabolic diseases.

Objectives: This systematic review and meta-analysis aimed to investigate the association between maternal overnutrition and offspring's blood pressure (BP) and the effect of offspring's obesity on this association.

Data sources: PubMed, EMBASE, Clinicaltrials.gov, CENTRAL.

Study selection and data extraction: Human studies published in English before October 2021 were identified that presented quantitative estimates of association between maternal overnutrition just before or during pregnancy and the offspring's BP.

Synthesis: Random-effect model with the DerSimonian and Laird weighting method was used to analyse regression coefficients or mean differences.

Results: After selection, 17 observational studies (140,517 mother-offspring pairs) were included. Prepregnancy body mass index (ppBMI) showed positive correlation with BP in offspring (regression coefficient for systolic: 0.38 mmHg per kg/m² , 95% confidence interval (CI) 0.17, 0.58; diastolic: 0.10 mmHg per kg/m² , 95% CI 0.05, 0.14). These indicate 1.9 mmHg increase in systolic and 0.5 mmHg increase in diastolic BP of offspring with every 5 kg/m² gain in maternal ppBMI. Results on coefficients adjusted for offspring's BMI also showed association (systolic: 0.08 mmHg per kg/m² , 95% CI 0.04, 0.11; diastolic: 0.03 mmHg per kg/m² , 95% CI 0.01, 0.04). Independent from ppBMI, gestational weight gain (GWG) showed positive correlation with systolic BP (systolic BP: 0.05 mmHg per kg, 95% CI 0.01, 0.09), but not after adjustment for offspring's BMI. Mean systolic BP was higher in children of mothers with excessive GWG than in those of mothers with optimal GWG (difference: 0.65 mmHg, 95% CI 0.25, 1.05).

Conclusions: Independent from offspring's BMI, higher prepregnancy BMI may increase the risk for hypertension in offspring. The positive association between GWG and offspring's systolic BP is indirect via offspring's obesity. Reduction in maternal obesity and treatment of obesity in children of obese mothers are needed to prevent hypertension.

Keywords: blood pressure; developmental programming; gestational weight gain; hypertension; maternal obesity.

FIGURE 1

Flow chart of the study selection procedure

FIGURE 2

Regression coefficients (B) describing the association between prepregnancy body mass index and offspring's systolic (upper panel n = 28,682 mother‐offspring pairs) or diastolic blood pressure (lower panel n = 19,385 mother‐offspring pairs). The coefficients are not adjusted for offspring's actual nutritional state (model 1). Horizontal bars indicate 95% confidence intervals (95% CI). Diamonds show the overall point estimate with 95% CI

FIGURE 3

Regression coefficients (B) adjusted for offspring's actual nutritional state (model 2) describing the association between prepregnancy body mass index and offspring's systolic (upper panel n = 26134 mother‐offspring pairs) or diastolic blood pressure (lower panel n = 16603 mother‐offspring pairs). Horizontal bars indicate 95% confidence intervals (95% CI). Diamonds show the overall point estimate with 95% CI

FIGURE 4

Regression coefficients (B) describing the association between gestational weight gain and offspring's systolic (upper panel n = 96424 mother‐offspring pairs) or diastolic blood pressure (lower panel n = 95587 mother‐offspring pairs). The coefficients are not adjusted for offspring's actual nutritional state (model 1). Horizontal bars indicate 95% confidence intervals (95% CI). Diamonds show the overall point estimate with 95% CI

FIGURE 5

Regression coefficients (B) adjusted for offspring's actual nutritional state (model 2) describing the association between gestational weight gain and offspring's systolic (upper panel n = 7349 mother‐offspring pairs) or diastolic blood pressure (lower panel n = 6276 mother‐offspring pairs). Horizontal bars indicate 95% confidence intervals (95% CI). Diamonds show the overall point estimate with 95% CI

FIGURE 6

Differences in mean systolic blood pressure values without (model 1, upper panel n = 5213 mother‐offspring pairs) and with adjustment for offspring's actual nutritional state (model 2, lower panel n = 10,603 mother‐offspring pairs) in offspring of mothers with excessive gestational weight gain (GWG) compared with those of adequate GWG. Horizontal bars indicate 95% confidence intervals (95% CI). Diamonds show the overall point estimate with 95% CI