番茄社区

NATIONAL HARBOR, Md. -- Moms who had hypertensive disorders of pregnancy (HDP) or gestational diabetes mellitus (GDM) were more likely to have kids with worse cardiovascular health (CVH) in adolescence, a secondary analysis of an observational cohort study found.

Adjusted models showed higher risks for less-than-ideal CVH in kids ages 10 to 14 when mothers had HDP and GDM together (adjusted risk ratio [aRR] 1.17, 95% CI 1.00-1.38) or either HDP alone (aRR 1.16, 95% CI 1.04-1.28) or GDM alone (aRR 1.11, 95% CI 1.02-1.21), reported Kartik K. Venkatesh, MD, PhD, of the Ohio State University in Columbus.

"While cardiovascular disease in children and adolescents is rare, adverse cardiometabolic risk factors, including elevated blood pressure, glucose, body mass index or BMI, and cholesterol are common," said Venkatesh in a presentation at the Society for Maternal-Fetal Medicine annual meeting.

The findings came from the HAPO Follow-up Study, and included 3,317 mother-child dyads. Of the pregnant individuals in the study, 7.9% developed HDP, 12.1% developed GDM, and 2.5% developed both. For the offspring, 46% had all ideal CVH metrics at ages 10 to 14 years, while 54% had at least one metric indicating less-than-ideal CVH: 36% had one or more intermediate metric, 16% had one poor metric, and 2% had two or more poor metrics.

Venkatesh pointed out that "adults with poor CVH are themselves more likely to experience an adverse pregnancy outcome, and the intergenerational cycle continues." Venkatesh noted that both HDP and GDM are on the rise in the U.S., which is cause for concern.

Cynthia Gyamfi-Bannerman, MD, of the University of California San Diego, told 番茄社区 that the study's results "suggest that finding ways to mitigate maternal complications of pregnancy and hypertensive disorders of pregnancy may benefit their children in the long term."

Venkatesh said future research should assess how behavioral factors play a role, as well as how interventions in pregnancy or childhood can positively impact CVH.

The was a prospective cohort that initially examined pregnant women from 2013 to 2016. Exposure of HDP and GDM were assessed through delivery and then child CVH was assessed 10 to 14 years after delivery. Exclusion criteria included preterm births, fetal anomalies, pregestational diabetes, and chronic hypertension. Mean maternal age at pregnancy was 30.4 years and the average age of the child at follow up was 11.6 years.

HDP exposure included gestational hypertension or preeclampsia regardless of severity, diagnosed with International Society for the Study of Hypertension in Pregnancy criteria from 20 weeks gestation through delivery. GDM was measured via a 2-hour 75-g oral glucose test at 28 weeks using International Association of the Diabetes and Pregnancy Study Groups criteria.

Measurements of glucose, BMI, total cholesterol, and blood pressure were used to assess the primary outcome of child CVH. Outcomes were scored using pediatric guidelines as ideal, intermediate, or poor, and total CVH was assessed via four mutually exclusive categories: all ideal metrics, one or more intermediate (but no poor) metric, one poor metric, or two or more poor metrics. Secondary analysis examined whether CVH was impacted by the number of non-ideal metrics.

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