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Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence - 22/05/24

Doi : 10.1016/j.ajog.2024.04.037 
Kartik K. Venkatesh, MD, PhD a, , Amanda M. Perak, MD b, c, Jiqiang Wu, MSc a, Patrick Catalano, MD d, Jami L. Josefon, MD c, Maged M. Costantine, MD a, Mark B. Landon, MD a, Nicola Lancki, MPH b, Denise Scholtens, PhD b, William Lowe, MD d, Sadiya S. Khan, MD, MSc b, e, William A. Grobman, MD, MBA a
a Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 
b Department of Preventive Medicine, Northwestern University, Chicago, IL 
c Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 
d Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University, Boston, MA 
e Department of Medicine, Northwestern University Feinberg School of Medicine Chicago, IL 

Corresponding author: Kartik K. Venkatesh, MD, PhD.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 22 May 2024

Abstract

Background

Adverse pregnancy outcomes, including hypertensive disorders of pregnancy and gestational diabetes mellitus, influence maternal cardiovascular health long after pregnancy, but their relationship to offspring cardiovascular health following in-utero exposure remains uncertain.

Objective

To examine associations of hypertensive disorders of pregnancy or gestational diabetes mellitus with offspring cardiovascular health in early adolescence.

Study Design

This analysis used data from the prospective Hyperglycemia and Adverse Pregnancy Outcome Study from 2000 to 2006 and the Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study from 2013 to 2016. This analysis included 3317 mother-child dyads from 10 field centers, comprising 70.8% of Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study participants. Those with pregestational diabetes and chronic hypertension were excluded. The exposures included having any hypertensive disorders of pregnancy or gestational diabetes mellitus vs not having hypertensive disorders of pregnancy or gestational diabetes mellitus, respectively (reference). The outcome was offspring cardiovascular health when aged 10–14 years, on the basis of 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Each metric was categorized as ideal, intermediate, or poor using a framework provided by the American Heart Association. The primary outcome was defined as having at least 1 cardiovascular health metric that was nonideal vs all ideal (reference), and the second outcome was the number of nonideal cardiovascular health metrics (ie, at least 1 intermediate metric, 1 poor metric, or at least 2 poor metrics vs all ideal [reference]). Modified poisson regression with robust error variance was used and adjusted for covariates at pregnancy enrollment, including field center, parity, age, gestational age, alcohol or tobacco use, child’s assigned sex at birth, and child’s age at follow-up.

Results

Among 3317 maternal-child dyads, the median (interquartile) ages were 30.4 (25.6–33.9) years for pregnant individuals and 11.6 (10.9–12.3) years for children. During pregnancy, 10.4% of individuals developed hypertensive disorders of pregnancy, and 14.6% developed gestational diabetes mellitus. At follow-up, 55.5% of offspring had at least 1 nonideal cardiovascular health metric. In adjusted models, having hypertensive disorders of pregnancy (adjusted risk ratio, 1.14 [95% confidence interval, 1.04–1.25]) or having gestational diabetes mellitus (adjusted risk ratio, 1.10 [95% confidence interval, 1.02–1.19]) was associated with a greater risk that offspring developed less-than-ideal cardiovascular health when aged 10–14 years. The above associations strengthened in magnitude as the severity of adverse cardiovascular health metrics increased (ie, with the outcome measured as ≥1 intermediate, 1 poor, and ≥2 poor adverse metrics), albeit the only statistically significant association was with the “1-poor-metric” exposure.

Conclusion

In this multinational prospective cohort, pregnant individuals who experienced either hypertensive disorders of pregnancy or gestational diabetes mellitus were at significantly increased risk of having offspring with worse cardiovascular health in early adolescence. Reducing adverse pregnancy outcomes and increasing surveillance with targeted interventions after an adverse pregnancy outcome should be studied as potential avenues to enhance long-term cardiovascular health in the offspring exposed in utero.

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Key words : adverse pregnancy outcomes, cardiovascular health, child health, gestational diabetes, hypertensive disorders of pregnancy, pregnancy


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 The authors report no conflict of interest.
 This study was presented at the Society for Maternal-Fetal Medicine 43rd Annual Pregnancy Meeting during Oral Plenary Session no. 1 (Abstract no. 2), San Francisco, CA, February 12, 2024.
 The Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study (HAPO FUS) was conducted by the HAPO FUS Investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the American Diabetes Association. The HAPO study was supported by the National Institute of Child Health and Human Development and the American Diabetes Association. The data from the HAPO FUS reported here were supplied by the NIDDK Central Repository. This manuscript was prepared in collaboration with some of the investigators of the HAPO FUS and does not necessarily reflect the opinions or views of the HAPO FUS, the NIDDK Central Repository, or the NIDDK. A.M.P. was supported by a K23HL145101, Northwestern Clinical and Translational Sciences Institute, Northwestern Memorial Foundation Dixon Translational Research Grant, American Heart Association 17SFRN33660752 subcontracted collaborative award, and Woman’s Board of Northwestern Memorial Hospital Eleanor Wood-Prince Grant. K.K.V. was supported by the Care Innovation and Community Improvement Program at The Ohio State University. S.S.K. was supported by the National Heart, Lung, and Blood Institute grant no. HL161514.
 Cite this article as: 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 2024;XX:x.ex–x.ex.


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