Chronic Maternal Hypertension Increases Risk for Pediatric Morbidity, Obesity

Babies born to mothers with chronic hypertension were twice as likely to develop endocrine-metabolic morbidities by age 18 and significantly more likely to be obese during childhood, according to a study published in Childhood Obesity.

To analyze the impact of maternal chronic hypertension on the long-term endocrine health of offspring, researchers conducted a retrospective cohort study on all women who gave birth at the Soroka University Medical Center (SUMC) in Israel from 1991 to 2014.

Women were screened for hypertension either before pregnancy (at least 12 weeks after a previous pregnancy) or during pregnancy before 20 weeks gestation. Women with a documented history of chronic hypertension were included in the hypertensive group regardless of antihypertensive medication use or control status. Populations excluded from the study included multiple gestations, fetuses with congenital malformations, and all women diagnosed with other pregnancy-related hypertensive disorders. Children were evaluated during any hospitalizations up to age 18 at SUMC for endocrine and metabolic morbidity.

A total of 232,841 singleton deliveries met the inclusion criteria; 1.1% of deliveries (n=2655) included mothers with chronic hypertension. Compared with the control group, the hypertensive group had a higher mean maternal age (32.6 vs 28.1 years), a higher likelihood of >5 deliveries (40.5% vs 25.2%), 5 times greater prevalence of gestational diabetes, and increased likelihood of preterm delivery, 

Researchers recorded a total of 1085 offspring hospitalizations that involved endocrine and metabolic morbidity up to 18 years of age. The rate of endo-metabolic-related hospitalizations was doubled in the hypertensive group compared with the normotensive group (1% vs 0.5%). Childhood obesity rates were also significantly higher in the hypertensive offspring group (0.7% vs 0.2%).

The study authors used a Cox model to demonstrate the link between endocrine-related hospitalizations and maternal chronic hypertension while controlling for gestational age at birth, maternal diabetes mellitus, and maternal obesity. Exposure to maternal chronic hypertension was found to be a significant, independent risk factor for offspring endocrine and metabolic morbidity (hazard ratio=1.5; 95% CI, 1.01-2.22). This significant independent association remained true in several analyses of other variables, including ethnicity, calendar year of birth, cesarean delivery, and neonatal birth weight. The Cox model also displayed a significant and independent association between maternal chronic hypertension and childhood obesity (HR=3.45; 95% CI, 2.2-5.5).  

“To the best of our knowledge, this is the first study to evaluate the impact of maternal chronic hypertensive disorders during pregnancy on the incidence of endocrine and metabolic morbidity of the offspring,” the study authors said. “Although intuitive, it is yet to be determined whether optimal treatment and surveillance in pregnancies involving chronic hypertension will positively impact not only perinatal outcome but also alter offspring health.”

Reference

Imterat M, Wainstock T, Landau D, Walfisch A, Sheiner E. Maternal chronic hypertension elevates risk for long-term selected endocrine and metabolic morbitity in the offspring, particularly childhood obesity. Child Obes. Published online June 24, 2020. doi:10.1089/chi.2019.0304

This article originally appeared on Clinical Advisor