Prenatal and Perinatal Factors of Life's Essential 8 Cardiovascular Health Trajectories

Abstract

Importance: The American Heart Association put forth the Life's Essential 8 construct to assess cardiovascular health (CVH) based on 8 biological and behavioral factors. Few studies have identified prenatal and perinatal factors of CVH trajectories across childhood and adolescence, life stages where disease precursors and health behaviors are established.

Objective: To examine associations of prenatal and perinatal factors with child CVH trajectory.

Design, setting, and participants: Data from the Project Viva prebirth cohort from April 1999 to August 2021 were used. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Data were analyzed from April 1 to September 30, 2024.

Exposures: Prenatal and perinatal factors.

Main outcomes and measures: CVH score (0-100 points), calculated as the unweighted average of all available CVH metrics at each life stage.

Results: Among 1333 children included, 680 (51.0%) were male, 78 (5.9%) Hispanic, 181 (13.6%) non-Hispanic Black, and 959 (71.9%) non-Hispanic White. The estimated mean (SD) age of inflection when CVH started to decline was 10.2 (0.7) years for male children and 10.0 (0.6) years for female children. Prepregnancy overweight or obesity (vs healthy or underweight), smoking during pregnancy (vs never), and formula-feeding (vs breastfeeding) in the first 6 months were each associated with lower CVH from childhood to adolescence, but gestational diabetes (vs normal glucose tolerance) was not associated with CVH. Prepregnancy obesity was associated with later inflection (β = 0.1; 95% CI, 0.0 to 0.2 years) and slower CVH decline after inflection (β = 0.2; 95% CI, 0.1 to 0.4 points per year). Gestational hypertension or preeclampsia (vs normal blood pressure) was associated with faster CVH gain before inflection (β = 0.3; 95% CI, 0.1 to 0.5 points per year), earlier inflection (β = -0.1; 95% CI, -0.2 to 0.0 years), and faster CVH decline after inflection (β = -0.3; 95% CI, -0.5 to -0.1 points per year), while smoking during pregnancy was associated with later inflection (β = 0.2; 95% CI, 0.1 to 0.3 years).

Conclusions and relevance: In this cohort study, prepregnancy overweight or obesity, smoking during pregnancy, and formula-feeding in the first 6 months of life were each associated with adverse CVH trajectories early in life. Future work should examine whether interventions that address these factors would be effective in optimizing CVH in children.

Figure 1.. Unadjusted Trajectories of Overall Cardiovascular Health (CVH) Scores From Early Childhood to Late Adolescence

Trajectories according to prepregnancy body mass index (A), gestational weight gain (B), hypertensive disorders of pregnancy (C), and gestational glucose tolerance (D). Shaded areas indicate 95% CIs. BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); GH, gestational hypertension; PE, preeclampsia.

Figure 2.. Unadjusted Trajectories of Overall Cardiovascular Health (CVH) Score From Early Childhood to Late Adolescence

Trajectories according to prenatal smoking status (A), breastfeeding initiation (B), and infant feeding type in the first 6 months (C). Shaded areas indicate 95% CIs.