Women who develop high blood pressure or diabetes in the course of pregnancy are more likely to give birth to children who develop conditions that may compromise their own heart health at a young age, scientists reported on Monday.
By the time they are 12 years old, these children are more likely to be overweight or to be diagnosed with high blood pressure, high cholesterol or high blood sugar, compared with children whose mothers had complication-free pregnancies.
The research underscores the strong association between healthy pregnancies and child health, though the study stops short of proving a cause-and-effect relationship. The conclusions also offer support for the “fetal origins of adult disease” hypothesis, which suggests that many chronic conditions may have roots in fetal adaptations to the uterine environment.
The findings come from a government-supported study that has followed an international cohort of 3,300 mother-and-child pairs for over a decade. The research was presented at the Society for Maternal Fetal Medicine’s annual pregnancy meeting in National Harbor, Md. An abstract was published in a supplement to the American Journal of Obstetrics and Gynecology in January.
“It sets up a potentially vicious cycle for the children, where the child is at higher risk for cardiovascular disease, and then when these girls become women and get pregnant themselves, they’re already more likely to have more severe hypertension and diabetes in pregnancy,” said Dr. Kartik K. Venkatesh, the paper’s first author, an obstetrician and perinatal epidemiologist at the Ohio State University Wexner Medical Center in Columbus.
The findings indicate the urgency of preventive care and early intervention, both during pregnancy and in early childhood, in order to stop the cycle, he added.
“The impact for the children is decades from now, so the question becomes: What can we do in the here and now to preserve their cardiovascular health across the life span?” Dr. Venkatesh said.
“Can we pick up abnormalities in cardiovascular health early on, so that we can treat them and implement interventions that could change the long-term outcomes?”
Women who are planning a pregnancy, too, may benefit from seeking care even before they conceive, he added. More women are starting pregnancies with conditions — such as obesity, high blood pressure and diabetes — that raise the odds of heart disease. Part of the reason: Women are postponing motherhood until later in their lives.
Of 3,317 pregnant women in the study, 263 (8 percent) developed pregnancy-related high blood pressure, 402 (12 percent) got gestational diabetes, and 82 (2.5 percent) were diagnosed with both conditions during pregnancy.
By the time they are 12, those whose mothers had high blood pressure during the pregnancy faced a 16 percent higher risk of having an indicator of heart trouble, like high cholesterol or overweight, compared with those born to mothers without complications.
The children born to mothers with gestational diabetes were 11 percent more likely to have such an indicator, the researchers found. And children of mothers with both conditions were nearly 20 percent more likely to have an early sign of cardiovascular problems.
Dr. Rachel M. Bond, a cardiologist and system director of Women’s Heart Health at Dignity Health in Chandler, Ariz., said the findings were significant and could lead to earlier screening for and treatment of heart disease in children.
“I think this will actually change pediatric guidelines and change how we care for patients,” Dr. Bond said. “If your mother had an adverse outcome in pregnancy, maybe we should be screening you earlier. We need to encourage people to know about their family medical history, including the complications their mothers had during pregnancy.”
Although there are no such guidelines yet, she added, “we are starting the conversation.”
Dr. Annette Ansong, associate chief of outpatient cardiology at Children’s National Hospital in Washington D.C., said she had already started to incorporate questions about maternal pregnancy health when taking her young patients’ medical history.
“I’ve started to ask the patient’s parents, ‘When you were pregnant, did you have pre-eclampsia, hypertension or diabetes?’ I didn’t do that before, and my guess is the majority of physicians don’t,” Dr. Ansong said.
“With a family history, you’re more or less focused on parents, aunts and uncles, grandparents, and what we don’t usually ask is, ‘What was going on in utero, inside mom’s belly?,’” she added.
