Adverse pregnancy outcomes is associated with worse offspring cardiovascular health in early adulthood

1. Exposure to adverse pregnancy outcomes, particularly hypertensive disorders of pregnancy, was associated with worse cardiovascular health and early arterial injury among offspring in early adulthood.

Evidence Rating Level: 2 (Good)

Study Rundown: Adverse pregnancy outcomes (APOs) have been associated with long-term maternal cardiovascular health (CVH). However, research on the role of APOs in CVH of offspring across the life course is lacking. This study thus examined the association between APO exposure and cardiovascular health among offspring in young adulthood. This longitudinal cohort study included mother-child dyads enrolled at the child’s birth, with offspring followed up until young adulthood (year 22). The exposures were the APOs hypertensive disorders of pregnancy (HDP), gestational diabetes (GD), and preterm birth (PTB). The primary outcomes were offspring CVH (Life’s Essential 8 [LE8] score), clinical cardiovascular risk factors, and arterial injury at year 22 after birth. Of the 1,333 offspring participants included in the study, 128 (10%) had HDP exposure, 67 (5%) had GD exposure, and 137 (10%) had PTB exposure. After adjusting for sociodemographic factors, HDP exposure was associated with higher body mass index, higher diastolic blood pressure, and higher glycated hemoglobin (HbA1c) level in early adulthood. PTB was associated with a higher HbA1c level. GD exposure was associated with a lower LE8 blood pressure score. HDP exposure and GD exposure were each associated with higher mean carotid intima-media thickness. HDP exposure was also associated with lower carotid grayscale. Overall, this study found that exposure to APOs, particularly HDP, was associated with worse CVH and early arterial injury among offspring in early adulthood. 

Click to read the study in JAMA Network Open 

Relevant reading: Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence

In-Depth [Cohort study]: This study analyzed data from the Future of Families and Child Well-Being Study and Future of Families—Cardiovascular Health Among Young Adults study. Mother-child dyads were enrolled at the child’s birth across 20 US cities from February 1998 to September 2000. Offspring were followed up until young adulthood (year 22). The exposures included HDP (pregnancy-associated hypertension, preeclampsia, and/or eclampsia), GD, and PTB (birth at <37 weeks’ gestational age). The primary outcomes were offspring CVH assessed by the American Heart Association’s LE8 score, individual clinical cardiovascular risk factors, and arterial injury assessed by carotid ultrasonography at year 22 after birth. Of the 1,333 offspring participants included in the study (mean [SD] age in early adulthood, 22.4 [0.7] years; 729 [55%] female), 128 (10%) had HDP exposure, 67 (5%) had GD exposure, and 137 (10%) had PTB exposure. After adjusting for sociodemographic factors, HDP exposure was associated with higher body mass index (adjusted β, 2.80; 95% CI, 1.07-4.53), higher diastolic blood pressure (adjusted β, 2.29; 95% CI, 0.17-4.41), and higher glycated hemoglobin (HbA1c) level (adjusted β, 0.21; 95% CI, 0.02-0.41) among offspring in early adulthood. PTB was associated with higher HbA1c level (adjusted β, 0.29; 95% CI, 0.15-0.43). No associations were found between GD exposure and clinical risk factors. GD exposure was associated with a lower LE8 blood pressure score (adjusted β, −6.59; 95% CI, −13.95 to −0.16). HDP exposure and GD exposure were each associated with higher mean carotid intima-media thickness (HDP: adjusted β, 0.02; 95% CI, 0.01-0.03; GD: adjusted β, 0.02; 95% CI, 0.00-0.04). HDP exposure was also associated with lower carotid grayscale median (adjusted β, −3.68; 95% CI, −6.30 to −1.05). No associations were found between PTB and measures of early arterial injury. Overall, this study found that exposure to APOs during gestation, particularly HDP, was associated with worse CVH and early arterial injury among offspring in early adulthood. These findings highlight the importance of optimizing maternal health during pregnancy for supporting better offspring CVH into early adulthood. Strengths of this study include the large sample size, longitudinal study design, and use of objective measures for APO status, arterial injury, and CVH. Some limitations include the low prevalence of APOs in the sample, the observational nature of the study, and not correcting for multiple hypothesis testing, which may increase the risk of false positives. Future studies should address these limitations and explore whether the association between APOs and offspring CVH is influenced by sex differences or social risk factors.

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