Children Born to Mothers With Cardiometabolic Issues Before or During Pregnancy Face Increased Risk of Childhood, Adolescent Hypertension

Children who are born to mothers who have cardiometabolic issues either before or during pregnancy may have an increased risk of elevated blood pressure during their childhood and adolescence, according to research published by investigators in JAMA Network Open. The study, which was funded by the Environmental Influences on Child Health Outcomes (ECHO) program at the National Institutes of Health, also showed that these children experienced an increased rate of change in blood pressure over a period of time, suggesting there is a long-term impact present.¹

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High blood pressure in childhood often continues into adulthood and contributes to a greater risk of heart problems later in life, explained experts in an accompanying news release.² Despite this knowledge, it is unclear what specific determinants may contribute to high blood pressure in children, as well as whether offspring can inherit them from their mothers. For this cohort study, the investigators enrolled mother-offspring pairs to examine the association of maternal cardiometabolic risk factors during pregnancy with offspring blood pressure from age 2 to 18 years. Additionally, the investigators evaluated whether associations were modified by sex, race, and ethnicity.^1,2

The cohort study analyzed data from the ECHO program between January 1, 1994, and March 31, 2023. A total of 12,480 mother-offspring pairs were included, and the 3 most common maternal cardiometabolic risk factors during pregnancy—prepregnancy obesity, gestational diabetes, and hypertensive disorders of pregnancy (HDP)—were retrieved from medical records and patient questionnaires. The main outcome measures were offspring systolic blood pressure (SBP) and diastolic blood pressure (DBP) percentiles, which were adjusted and calculated after taking age, sex, and height into consideration.¹

Among the 12,480 mother-offspring pairs (mean maternal age during pregnancy: 29.9 years), most were White (n = 6522; 52.3%), followed by Hispanic (n = 2305; 18.7%), Black (n = 1908; 15.5%), Asian (n = 856; 7.0%), and other race and ethnicity (n = 712; 5.8%). Additionally, at least 1 cardiometabolic risk factor was present in about 44.4% (n = 5537) of participants, with prepregnancy being the most common (n = 3072; 24.6%), followed by HDP (n = 1693; 13.6%) and gestational diabetes (n = 805; 6.5%).¹

The authors observed that, after adjusting for potential confounders, offspring born to mothers with any cardiometabolic risk factors had higher SBP (4.88 percentile points; 95% CI, 3.97-5.82) and higher DBP (1.90 percentile points; 95% CI, 1.15-2.64) at the time of their first blood pressure measurement, compared with those who did not have any risk factors. HDP, whether on its own or with either prepregnancy obesity or gestational diabetes, was significantly associated with higher offspring blood pressure.¹

Further, these associations were generally more prevalent among female and Black offspring compared with male offspring or those of other racial and ethnic groups. In addition, among 6015 offspring who had 2 or more blood pressure measures, maternal cardiometabolic risk factors were associated with an increased rate of SBP (0.5 [95% CI, 0.2-0.8] per year) and DBP (0.7 [95% CI 0.5-1.0] per year) change from age 2 to 18 years.¹

Overall, the findings indicate that protecting pregnant individuals from cardiometabolic risk factors can improve their health while simultaneously promoting healthier blood pressure in their offspring.¹ The researchers emphasized that further studies will need to be conducted to understand how combinations of maternal health complications and broader social and/or structural factors may contribute to these longer-term risks.²

“With declines in cardiometabolic health, it’s important to focus on prevention starting as early as possible,” ECHO researcher Zhongzheng Niu, PhD, Keck School of Medicine at the University of Southern California, said in a news release. “Our study suggests that helping people improve their health before and during pregnancy could benefit both mothers and future generations."²

REFERENCES

1. Niu Z, Ako AA, Geiger SD, et al. Maternal Cardiometabolic Risk Factors in Pregnancy and Offspring Blood Pressure at Age 2 to 18 Years.  JAMA Netw Open. 2025;8(5):e259205. doi:10.1001/jamanetworkopen.2025.9205

2. Environmental Influences on Child Health Outcomes. Maternal cardiometabolic health during pregnancy associated with higher blood pressure in children, NIH study finds. News release. May 8, 2025. Accessed May 12, 2025. https://www.eurekalert.org/news-releases/1083208