Maternal hypertension and diabetes linked to worse offspring cardiovascular health
A new study finds that children born to mothers with hypertensive disorders of pregnancy or gestational diabetes are at a higher risk of developing cardiovascular health issues by ages 10 to 14 years.
Maternal hypertension and diabetes linked to worse offspring cardiovascular health | Image Credit: © CasanoWa Stutio - © CasanoWa Stutio - stock.adobe.com.
The risk of worse cardiovascular health (CVH) is significantly increased among offspring of mothers with hypertensive disorders of pregnancy (HDP) or gestational diabetes mellitus (GDM) during pregnancy, according to a recent study published in the American Journal of Obstetrics & Gynecology.1
Increases in HDP and GDM rates have been observed, from 39 and 48 per 1000 live births, respectively, in 2007 to 78 and 64 per 1000 live births, respectively, in 2019. These conditions have been linked to adverse maternal CVH risks after pregnancy.2
Adverse cardiometabolic risk factors are common in children and adolescents, and the fetal period is considered critical for metabolic programming that may impact CVH.1 However, according to investigators, the impact of HDP and GDM during pregnancy “on CVH in the offspring exposed in utero remains to be fully defined.”
The study was conducted to determine the impact of HDP and GDM on offspring CVH. Pregnant women and their offspring aged 10 to 14 years enrolled in the Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study were included in the analysis.
Participants were blind to the results of the oral glucose test during pregnancy, delivered at a gestational age of 37 weeks or later, and had no major fetal or neonatal malformations or death. Exclusion criteria included chronic hypertension during index pregnancy and pregestational diabetes.
Alongside the 75-g oral glucose tolerance test, maternal height, weight, and blood pressure were obtained at enrollment. Additionally, a questionnaire was administered to determine demographic and lifestyle characteristics.
During the follow-up, children aged 10 to 14 years underwent height and weight measurements to determine body mass index (BMI). Three blood pressure measurements were also performed in these individuals, with the last 2 measurements averaged and used in the analysis.
HDP vs no HDP and GDM vs no GDM were reported as exposure. HDP was determined based on a gestational diabetes or preeclampsia diagnosis, and GDM based on criteria from the International Association of Diabetes and Pregnancy Study Groups.
Offspring total CVH at age 10 to 14 years was the primary outcomes. This was based on BMI, blood pressure, total cholesterol level, and glucose level. These metrics were reported as ideal, intermediate, or poor, indicating scores of 2, 1, and 0 points, respectively. The total score ranged from 0 to 8 points.
There were 3317 maternal-child dyads included in the final analysis, with a median maternal age of 30.4 years and median gestational duration of 27.9 week at enrollment. The median BMI was 25.9 kg/m2, and mothers delivered at a median 39.9-weeks’ gestation. Offspring were aged a median 11.6 years at follow-up.
HDP was reported in 10.4% of pregnant patients and GDM in 14.6%. Offspring had a median CVH score of 7 at follow-up, with less-than-ideal CVH indicated by at least 1 metric score in 54.5%. All ideal CVH metrics were reported in 46.5% of offspring not exposed to HDP, 38.8% exposed to HDP, 46.5% not exposed to GDM, and 39.7% exposed to GDM.
Adjusted relative risks of having offspring with less-than-ideal CVH at age 10 to 14 years were 1.14 in pregnant patients exposed to HDP and 1.10 in those exposed to GDM.Additionally, associations were stronger in patients with more severe adverse CVH metrics.
Consistent associations were reported between HDP and GDM with offspring BMI scores. Each 1-point increase in offspring CVH score was linked to reduced odds of HDP and GDM.
These results indicated significantly increased risks of having offspring with worse CVH among pregnant patients with HDP and GDM. Investigators concluded “whether targeted CVH measurement and intervention after an adverse pregnancy outcome can positively impact child CVH across the lifespan requires further study.”
References
- Venkatesh KK, Perak AM, Wu J, et al. Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence. Am J Obstet Gynecol. 2025;232:218.e1-12. doi:10.1016/j.ajog.2024.04.037
- Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia. 2019;62(6):905-914. doi:10.1007/s00125-019-4840-2
