Hypertensive disorders of pregnancy, gestational diabetes may affect child’s heart health

Key takeaways:

• Hypertensive disorders of pregnancy and gestational diabetes raised the likelihood of having children with nonideal cardiovascular health
• The links were stronger as adverse maternal health metrics increased.

Women with hypertensive disorders of pregnancy, gestational diabetes or both had higher likelihood of having children with worse CV health 10 to 14 years after delivery, according to a presenter at The Pregnancy Meeting.

“We recognize that adverse pregnancy outcomes increase the risk of bad outcomes at birth for the mom and baby, and increasing data suggest that these outcomes can lead to long-term CV health outcomes for the mom. Data also suggest that the same may be true for kids. But the thing is, kids aren’t going to develop these cardiometabolic outcomes for maybe half a century because these are things that people develop much later in life,” Kartik Kailas Venkatesh, MD, PhD, maternal-fetal medicine subspecialist and assistant professor of obstetrics and gynecology and epidemiology at Ohio State University, told Healio. “What we looked at was if we could see an association between these adverse pregnancy outcomes and CV health at the cusp of adolescence.”

Venkatesh and colleagues conducted a secondary analysis of data from 3,317 maternal-child pairings from the prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS). Researchers evaluated relationships between factors in pregnancy — hypertensive disorders of pregnancy alone, gestational diabetes alone and both hypertensive disorders of pregnancy and gestational diabetes — and child CV health. Children’s CV health factors, including BMI, blood pressure, total cholesterol level and glucose level, was categorized as ideal, intermediate or poor using pediatric guidelines. Researchers also assessed the extent that exposures were associated with progressive decrements in CV health through categorizing CV health based on the number of nonideal metrics compared with all ideal metrics.

The primary outcome was at least one nonideal CV health metric at age 10 to 14 years.

Among the cohort, 7.9% of pregnant women developed hypertensive disorders of pregnancy, 12.1% developed gestational diabetes and 2.5% developed both hypertensive disorders of pregnancy and gestational diabetes.

At a median age of 11.6 years, 55.5% of children had at least one metric that indicated nonideal CV health. In adjusted models, women with only hypertensive disorders of pregnancy (adjusted RR = 1.16; 95% CI, 1.04-1.28), only gestational diabetes (aRR = 1.11; 95% CI, 1.02-1.21) and both conditions (aRR = 1.17; 95% CI, 1-1.38) had a higher likelihood of having children with nonideal CV health at age 10 to 14 years compared with women without these morbidities.

In secondary analyses, researchers found that associations were stronger as adverse CV health metrics increased in both number and severity.

According to Venkatesh, these findings highlight the potentially intergenerational cycle of cardiometabolic morbidities: Adverse pregnancy outcomes may lead to poor CV for children, who in turn have a higher likelihood of developing adverse pregnancy outcomes later on.

“Integration of CV health as a framework, as we did here, rather than focusing on disease, and thinking earlier about CV health as something that can be enhanced and preserved is a real magical moment for patients and providers,” Venkatesh said. “We can use this as an opportunity [to] enhance and preserve our CV health, and there are meaningful things we can do. It’s much better to intervene earlier … rather than wait until you develop a disease state, because by then your options are limited.”

For more information:

Kartik Kailas Venkatesh, MD, PhD, can be reached at kartik.venkatesh@osumc.edu.

Reference:

• Venkatesh KK, et al. Am J Obstet Gynecol. 2024;doi:10.1016/j.ajog.2023.11.016.