Journal Article Research Support, N.I.H., Extramural Epublish
PubMed: 40299384 DOI: 10.1001/jamanetworkopen.2025.7774
Prenatal and Perinatal Factors of Life's Essential 8 Cardiovascular Health Trajectories.
JAMA Netw Open 8(4):e257774
Authors: Izzuddin M Aris, Sheryl L Rifas-Shiman, Sarah D de Ferranti, Marie-France Hivert, Wei Perng
Affiliations
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
- Diabetes Unit, Massachusetts General Hospital, Boston.
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center and the Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora.
Abstract
Importance
The American Heart Association put forth the Life's Essential 8 construct to assess cardiovascular health (CVH) based on 8 biological and behavioral factors. Few studies have identified prenatal and perinatal factors of CVH trajectories across childhood and adolescence, life stages where disease precursors and health behaviors are established.
Objective
To examine associations of prenatal and perinatal factors with child CVH trajectory.
Design, setting, and participants
Data from the Project Viva prebirth cohort from April 1999 to August 2021 were used. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Data were analyzed from April 1 to September 30, 2024.
Exposures
Prenatal and perinatal factors.
Main outcomes and measures
CVH score (0-100 points), calculated as the unweighted average of all available CVH metrics at each life stage.
Results
Among 1333 children included, 680 (51.0%) were male, 78 (5.9%) Hispanic, 181 (13.6%) non-Hispanic Black, and 959 (71.9%) non-Hispanic White. The estimated mean (SD) age of inflection when CVH started to decline was 10.2 (0.7) years for male children and 10.0 (0.6) years for female children. Prepregnancy overweight or obesity (vs healthy or underweight), smoking during pregnancy (vs never), and formula-feeding (vs breastfeeding) in the first 6 months were each associated with lower CVH from childhood to adolescence, but gestational diabetes (vs normal glucose tolerance) was not associated with CVH. Prepregnancy obesity was associated with later inflection (β = 0.1; 95% CI, 0.0 to 0.2 years) and slower CVH decline after inflection (β = 0.2; 95% CI, 0.1 to 0.4 points per year). Gestational hypertension or preeclampsia (vs normal blood pressure) was associated with faster CVH gain before inflection (β = 0.3; 95% CI, 0.1 to 0.5 points per year), earlier inflection (β = -0.1; 95% CI, -0.2 to 0.0 years), and faster CVH decline after inflection (β = -0.3; 95% CI, -0.5 to -0.1 points per year), while smoking during pregnancy was associated with later inflection (β = 0.2; 95% CI, 0.1 to 0.3 years).
Conclusions and Relevance
In this cohort study, prepregnancy overweight or obesity, smoking during pregnancy, and formula-feeding in the first 6 months of life were each associated with adverse CVH trajectories early in life. Future work should examine whether interventions that address these factors would be effective in optimizing CVH in children.
MeSH
Pregnancy, Clinical Medicine, Obesity, Overweight, Smoking, Child