A young Asian boy holding a red heart in both hands to symbolize heart shape and links with congenital heart defect (CHD)
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Common cardiovascular-related pregnancy complications may result in worse future heart health for the child as well as the mother, a new study suggests. This large, collaborative study found signs of higher risk of cardiovascular disease and stroke in about half of children born after a pregnancy that featured hypertension or gestational diabetes. The work was presented this week at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, also known as The Pregnancy Meeting.

“These findings are important because traditionally, the thinking has been that a person’s risk of developing cardiovascular disease starts after birth—that everyone starts at the same point,” says the study’s lead author Kartik K. Venkatesh, MD, PhD, a maternal-fetal medicine subspecialist and assistant professor of obstetrics and gynecology and assistant professor of epidemiology, and Director of the Diabetes in Pregnancy Program at The Ohio State University. “These data suggest that’s not the case and that what happens in the womb can affect the child across their lifespan.”

The abstract was published in the January 2024 supplement of the American Journal of Obstetrics and Gynecology. William A. Grobman of The Ohio State University is senior author.

Hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM) are two of the most common pregnancy complications and put pregnant people at increased risk of developing cardiovascular disease later in life.

According to the CDC, the prevalence of HDP in pregnancy among delivery hospitalizations increased from about 13% in 2017 to 16% in 2019, affecting at least one in seven delivery hospitalizations during this period. The agency also reported that the percentage of people who received a diagnosis of gestational diabetes during pregnancy increased from 6.0% in 2016 to 8.3% in 2021. Increases in GDM were seen in each maternal age group, and rates rose steadily with maternal age.

This work comprised a secondary analysis of 3,317 maternal-child pairings from the prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS). Researchers examined whether there was a connection between HDP and GDM and a child’s later cardiovascular health.

Eight percent of the pregnant people in the study developed high blood pressure during pregnancy, 12 percent developed gestational diabetes, and three percent developed both high blood pressure and diabetes.

Researchers then examined the cardiovascular health of the children born of these pregnancies, 10 to 14 years after delivery. Cardiovascular health was evaluated based on four metrics: body mass index, blood pressure, total cholesterol, and glucose level. Pediatric guidelines categorized each metric as ideal, intermediate, or poor. Researchers found that before the age of 12 (median age: 11.6), more than half of the children (55.5%) had at least one metric that was non-ideal, which puts them at greater risk of heart disease and stroke.

Secondary analyses revealed that the associations strengthened in magnitude as the adverse cardiovascular health metrics increased in number and severity.

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