Effect of maternal cardiovascular conditions and risk factors on offspring cardiovascular disease.

Abstract

Cardiovascular diseases (CVDs) constitute a particular challenge during pregnancy because physiological changes and fetal demands create an additional burden and fetal safety concerns limit treatment options. Other articles of this series review the physiological changes during pregnancy, the management of cardiovascular conditions most likely to endanger maternal and fetal health, and their long-term consequences for the cardiovascular health of the mother. This article focuses on their consequences in offspring. Developmental programming resulting from in utero or early postnatal exposure to specific risk factors is increasingly recognized to determine CVD in later life. Clinically manifest cardiovascular conditions during pregnancy such as preeclampsia/eclampsia and gestational hypertension may not only affect maternal health and pregnancy outcome but also reduce fetal growth, which is associated with increased adult CVD. Furthermore, extensive evidence indicates that maternal cardiovascular risk factors (hypercholesterolemia, smoking, obesity, and diabetes mellitus) program endothelial dysfunction, insulin resistance (IR), hypertension, atherosclerosis, and type 2 diabetes mellitus in offspring. The mechanisms of developmental programming remain largely unknown, but specific factors affecting in utero programming have been identified and experimental models established in which causal relationships, mechanisms, and protective effects of maternal treatment can be explored. These findings suggest that interventions targeting in utero programming may reduce the susceptibility to CVD in offspring, a high priority given the increasing prevalence of obese and dysmetabolic mothers and the concomitant increase in lifestyle risk in children. However, neither the cardiovascular consequences of many maternal risk factors nor the efficacy of maternal prevention and treatment is sufficiently supported by prospective double-blind studies. The present review provides a critical evaluation of the associations between maternal cardiovascular conditions during pregnancy and offspring CVD, the role of low birth weight, and the evidence for developmental programming of CVD by other maternal cardiovascular risk factors. It then proposes an integrated view of …