Longitudinal association between maternal cardiovascular health in pregnancy and child birth outcomes

Abstract

The American Heart Association has updated its definition of cardiovascular health (CVH) with a new framework known as Life's Essential 8 (LE8). Although gestational CVH assessment has been recommended, its significance based on LE8 for birth outcomes is unknown. We thus evaluated the status of gestational CVH based on LE8 in 3036 pregnant women of the Shanghai Maternal-Child Pairs Cohort and the population of China Maternal Nutrition and Health Sciences Survey, and also examined the association between gestational CVH and child birth outcomes. We found that only a small proportion (12.84%) had high CVH, while 1.98% had low CVH in this cohort study. In adjusted models, a 10-point increase in the gestational CVH score, indicating a more favorable score, was associated with lower neonatal size such as birth weight (β: - 37.05 [95% confidence interval: - 52.93, - 21.16]), birth length (- 0.12[- 0.22, - 0.01]), weight-for-height z-score (- 0.07[- 0.12, - 0.03]), body mass index z-score (- 0.09 [- 0.13, - 0.04]), length-for-age Z-score (- 0.03 [- 0.06, - 0.01]), and weight-for-age z-score (- 0.08 [- 0.12, - 0.05]). Also, a 10-point increase in the gestational CVH score was associated with the lower risk of large for gestational age (LGA) (0.82 [0.73, 0.92]) and macrosomia infant (0.75 [0.64, 0.88]). CVH categories showed similar results. That is, better maternal CVH status in pregnancy was associated with lower neonatal size and lower risks for LGA and macrosomia in newborns.

Keywords: Adverse birth outcome; Birth weight; Cohort study; Life’s essential 8; Maternal cardiovascular health; Pregnant women.

Figure 1

Flowchart of study participants.

Figure 2

Status of individual cardiovascular health metrics among pregnant women. FPG fasting plasma glucose, TC total cholesterol, BP blood pressure, PA physical activity.

Figure 3

Rates of Adverse Birth Outcomes by Gestational CVH categories. *The star indicates a linear trend between different maternal CVH group and the rates of adverse birth outcomes by the Cochran-Armitage Trend Test. (P_trend < 0.05). CVH Cardiovascular Health, ABOs adverse birth outcomes, SGA small for gestational age, LGA Large for gestational age, LBW low birth weight.

Figure 4

Adjusted association of maternal gestational CVH score and categories with adverse birth outcomes. The adjusted model covariates include maternal age, maternal education level, maternal parity, average income per month, maternal alcohol use before pregnancy, GWG, paternal age, and infant sex. The red squares represent statistical significance for rates of adverse birth outcomes among different maternal CVH exposure. *The sample size was 1595. ^aA false discovery rate less than 0.05. CVH Cardiovascular Health, SGA small for gestational age, LGA Large for gestational age, LBW low birth weight.