Featuring: Amanda Perak, ’09 MD, ’18 MS
A mother’s heart health while she is pregnant may have a significant impact on her child’s cardiovascular health in early adolescence (ages 10 to 14), according to a new study from Northwestern Medicine and the Ann & Robert H. Lurie Children’s Hospital of Chicago.
The study, published in JAMA, is the first study to examine the implications of a mother’s cardiovascular health during pregnancy for offspring health in the longer term.
The findings are troubling, as they build upon previous Northwestern Medicine and Lurie Children’s Hospital research that found more than 90 percent of U.S. mothers have suboptimal cardiovascular health levels during pregnancy.
“Our new findings suggest that the children of this large group of mothers with suboptimal cardiovascular health may be at higher risk for early declines in their own cardiovascular health during childhood,” said lead author Amanda Perak, ’09 MD, ’18 MS, assistant professor of Pediatrics in the Division of Cardiology and of Preventive Medicine in the Division of Epidemiology. “If we can address these underlying causes of children’s poor heart health, we can hopefully help them avoid future heart attacks, strokes and premature deaths as they grow up.”
Perak also is a pediatric preventive cardiologist at Lurie Children’s Hospital.
Children born to mothers in the poorest category of cardiovascular health (representing 6 percent of mothers) had almost eight times higher risk for the poorest cardiovascular health category in early adolescence, compared with children born to mothers who had ideal cardiovascular health in pregnancy, the study found.
Children born to mothers with any “intermediate” cardiovascular health metrics in pregnancy — for example, being overweight but not obese — had over two times higher risk for the poorest cardiovascular health category in early adolescence, according to the study.
Analysis of multiple maternal risk factors at once
Most prior studies of the implications of a mother’s health on her offspring have examined just one maternal risk factor at a time (i.e. obesity or hypertension), Perak said.
“Our study combined multiple factors across a range of levels and found that the associations of maternal cardiovascular health with offspring cardiovascular health were not driven by any one metric (such as obesity),” Perak said. “Instead, all metrics were related to the offspring’s later health.”
How the study worked:
The study used data from the Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study, which was an observational study of pregnant women and their offspring. The scientists studied more than 2,300 mother-child pairs from six different countries. The pregnancies occurred between 2000 to 2006, and the children were examined at age 10 to 14 years from 2013 to 2016.
Using the American Heart Association’s definition for cardiovascular health, the scientists categorized cardiovascular health for mothers based on their levels of body mass index (an indicator of weight versus height), blood pressure, cholesterol, glucose and smoking status at 28 weeks gestation. The scientists categorized cardiovascular health for offspring based on their levels of body mass index, blood pressure, cholesterol and glucose at ages 10 to 14 years old.
“The children in this study are soon going to be adults and as a next step, we’d like to measure cardiovascular health and signs of early cardiovascular disease as they enter adulthood,” Perak said.
Additionally, she plans to investigate some of the underlying reasons why poorer maternal cardiovascular health in pregnancy might lead to poorer offspring cardiovascular health. For example, an adverse environment in the woman’s uterus may lead to differences in which the offspring’s genes are turned “on” or “off” at different times, which could be a reason for health differences, Perak said.
Funding for the study was provided by the National Institutes of Health (NIH) (grant K23HL145101); Pediatric Physician-Scientist Research Award; the Eleanor Wood-Prince Grant; the Dixon Translational Research Award; the American Heart Association (grants 17SFRN33660752, 17SFRN33660752, 17SFRN33700101, 17SFRN33700155); the National Center for Advancing Translational Sciences of the NIH (grant UL1TR001422). HAPO and HAPO FUS were funded by NICHD (grants R01HD34242, R01HD34243), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (grants R01DK095963, R01DK117491) and The Eunice Kennedy Shriver National Institute of Child Health and Human Development /NIDDK (grant 1U01DK094830).
This article was originally published in the Feinberg School of Medicine News Center on February 16, 2020 .
Amanda Perak, ’09 MD, ’18 MS, assistant professor of Pediatrics in the Division of Cardiology and lead author of the study.
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