Gestational hypertensive disorders and blood pressure and childhood cardiac outcomes: A prospective cohort study

Meddy Karmaoui, Clarissa Wiertsema, Annemarie Mulders, W.A. Helbing, Alexander Hirsch, Arno A.W. Roest, Vincent Jaddoe, Romy Gaillard*

*Corresponding author for this work

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Abstract

Objective: To assess whether gestational hypertensive disorders and higher gestational blood pressure were associated with subclinical changes in offspring cardiac structure and function during childhood. Design: Population-based prospective cohort study. Setting: Rotterdam, the Netherlands. Population: A cohort of 2502 mother–offspring pairs. Methods: Maternal blood pressure was measured in early, mid and late pregnancy, and information on gestational disorders were obtained from medical records. Offspring cardiac measurements were assessed by Cardiovascular Magnetic Resonance at 10 years. Main outcome measures: Left and right ventricular end-diastolic volumes (LVEDVs and RVEDVs), and ejection fractions, and left ventricular mass (LVM). Results: Offspring exposed to pre-eclampsia had a lower right ventricular ejection fraction (RVEF) (difference, −0.31 SDS; 95% CI −0.60, −0.02); however, no associations with other cardiac outcomes were present. Higher maternal diastolic blood pressure (DBP) in early and late pregnancy was associated with lower LVEDVs and RVEDVs (p < 0.05), with the strongest effect in early pregnancy. No associations of systolic blood pressure (SBP) with offspring outcomes were present. These associations persisted after additional adjustment for birth and child factors. Paternal SBP and DBP were not associated with offspring cardiac outcomes. Conclusions: No consistent associations of gestational hypertensive disorder status with childhood cardiac outcomes were present. Higher maternal DBP throughout pregnancy was associated with lower childhood LVEDVs and RVEDVs. Stronger maternal–offspring rather than paternal–offspring associations were present, which may suggest that suboptimal maternal gestational haemodynamic adaptations affects offspring cardiac structure through direct intrauterine effects. Further studies are needed to replicate these findings and examine the underlying mechanisms.

Original languageEnglish
Pages (from-to)1226-1237
Number of pages12
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume130
Issue number10
Early online date5 Apr 2023
DOIs
Publication statusPublished - Sept 2023

Bibliographical note

Funding Information:
The Generation R Study is financially supported by the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam and the Netherlands Organization for Health Research and Development, the Netherlands Organization for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport. Prof. Vincent V.W. Jaddoe received a grant from the European Research Council (consolidator grant ERC‐2014‐CoG‐648916). Dr Romy Gaillard received funding from the Dutch Heart Foundation (grant 2017T013), the Dutch Diabetes Foundation (grant 2017.81.002) and the NWO (ZonMW, grant 543003109). This project has received funding from the European Union's Horizon 2020 research and innovation programme under the ERA‐NET co‐fund action (727565), and the European Joint Programming Initiative ‘A Healthy Diet for a Healthy Life’ (JPI HDHL, EndObesity project, ZonMW the Netherlands, 529051026).

Funding Information:
information The Generation R Study is financially supported by the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam and the Netherlands Organization for Health Research and Development, the Netherlands Organization for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport. Prof. Vincent V.W. Jaddoe received a grant from the European Research Council (consolidator grant ERC-2014-CoG-648916). Dr Romy Gaillard received funding from the Dutch Heart Foundation (grant 2017T013), the Dutch Diabetes Foundation (grant 2017.81.002) and the NWO (ZonMW, grant 543003109). This project has received funding from the European Union's Horizon 2020 research and innovation programme under the ERA-NET co-fund action (727565), and the European Joint Programming Initiative ‘A Healthy Diet for a Healthy Life’ (JPI HDHL, EndObesity project, ZonMW the Netherlands, 529051026).The Generation R Study is conducted by the Erasmus Medical Center, in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam Area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst and Artsenlaboratorium Rijnmond (STAR). We gratefully acknowledge the contribution of the participating mothers, general practitioners, hospitals, midwives and pharmacies in Rotterdam.

Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

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