Abstract
Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) has previously been associated with offspring cardiometabolic risk factors, such as fat mass, glucose and insulin levels, and blood pressure, but these associations appear to be largely mediated by offspring BMI. To our knowledge, no studies have assessed alterations in the retinal microvasculature in association with maternal prepregnancy BMI. To investigate the association between maternal prepregnancy BMI and anthropometric parameters, blood pressure, and retinal vessel parameters in children age 4 to 6 years. Participants included mother-child pairs of the population-based Environmental Influence on Early Aging (ENVIRONAGE) birth cohort study (Flanders, Belgium) who were recruited at birth from February 2010 to June 2014 and followed-up at age 4 to 6 years between October 2014 and July 2018. Data were analyzed from February 2019 to April 2019. Maternal prepregnancy BMI based on height and weight measurements at the first antenatal visit (weeks 7-9 of gestation). Children's anthropometric, blood pressure, and retinal microcirculation measurements at age 4 to 6 years. Retinal vessel diameters and the tortuosity index, a measure for the curvature of the retinal vasculature, were obtained by fundus image analysis. This study included 240 mothers and children with a mean (SD) age of 29. 9 (4.2) years and 54.8 (4.7) months, respectively. Of these, 114 children (47.5%) were boys. Maternal prepregnancy BMI was positively associated with the child's birth weight, BMI, waist circumference, blood pressure, and retinal vessel tortuosity. A 1-point increase in maternal prepregnancy BMI was associated with a 0.26-mm Hg (95% CI, 0.08-0.44) higher mean arterial pressure for their children, with similar estimates for systolic and diastolic blood pressure. Independent from the association with blood pressure, a 1-point increase in maternal prepregnancy BMI was associated with a 0.40 (95% CI, 0.01-0.80) higher retinal tortuosity index (× 103). The hypothesis that these associations reflect direct intrauterine mechanisms is supported by the following observations: associations were independent of the current child's BMI and the estimates for paternal BMI at the follow-up visit did not reach significance. Considering that blood pressure tracks from childhood into adulthood and microvascular changes may be early markers of cardiometabolic disease development, our results suggest that maternal prepregnancy BMI is an important modifiable risk factor for later-life cardiovascular health of the offspring.
Highlights
The increasing prevalence of obesity is a global public health problem
A 1-point increase in maternal prepregnancy body mass index (BMI) was associated with a 0.26–mm Hg higher mean arterial pressure for their children, with similar estimates for systolic and diastolic blood pressure
Independent from the association with blood pressure, a 1-point increase in maternal prepregnancy BMI was associated with a 0.40 higher retinal tortuosity index (× 103)
Summary
The increasing prevalence of obesity is a global public health problem. Estimates suggest that more than 21% of women will have obesity by 2025,1 which is concerning considering that obesity during pregnancy is associated with adverse maternal and fetal pregnancy outcomes[2] and with potential long-term health effects in the context of the developmental origins of health and disease theory[3] and molecular longevity of the generation.[4]. Identifying blood pressure determinants in children is highly relevant given that blood pressure tracks from childhood into adulthood[8] and elevated blood pressure in adult life is a leading risk factor for cardiovascular disease (CVD).[9,10] A recent review concluded that the evidence for an association between maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and offspring’s blood pressure is limited and that this association is mainly mediated by offspring’s anthropometry. The authors concluded that good-quality studies on the association between maternal prepregnancy BMI and offspring’s mean arterial pressure are lacking.[11]
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