Association Between Maternal Hypertension and Childhood Obesity
There is a significant association between maternal hypertension during pregnancy and increased risk of childhood obesity in offspring. 1 This relationship appears to be influenced by maternal BMI, but maternal hypertension remains an independent risk factor for childhood metabolic disorders.
Evidence for the Association
Maternal chronic hypertension is independently associated with long-term childhood endocrine and metabolic morbidity, with childhood obesity being significantly more common in offspring of mothers with chronic hypertension (0.7% vs. 0.2% in normotensive mothers) 1
Blood pressure elevation during pregnancy, even within the normal range, is associated with increased risk of offspring overweight/obesity at ages 4-7 years. Each 10-mm Hg greater rise in blood pressure between first and third trimesters was associated with a higher risk for offspring overweight/obesity 2
Hypertension during the second and third trimesters of pregnancy was associated with 49% and 14% higher risks for childhood overweight/obesity, respectively 2
Mediating Factors and Mechanisms
Maternal pre-pregnancy BMI appears to be a significant mediator in this relationship. When adjusting for maternal BMI, the association between gestational hypertension and childhood overweight is attenuated but still present in late childhood 3
The American Heart Association recognizes that pathological studies have shown both the presence and extent of atherosclerotic lesions at autopsy correlate positively with established risk factors, including systolic and diastolic blood pressure and body mass index 4
The relationship between maternal hypertension and childhood obesity may be part of a broader pattern of cardiovascular risk factor clustering that begins in early childhood 4
Clinical Implications
For children of mothers with hypertensive disorders during pregnancy, more vigilant monitoring of body weight and metabolic parameters is warranted 1
The risk appears to increase with the child's age, suggesting that early intervention is important 1
In mothers with gestational diabetes mellitus (GDM), concurrent hypertensive disorders during pregnancy further increase the risk of offspring macrosomia at birth and childhood overweight/obesity at 1-5 years 5
Prevention Strategies
While controlling maternal hypertension during pregnancy is important for preventing adverse pregnancy outcomes, preventive strategies for reducing childhood obesity should focus primarily on maternal BMI 3
The American Heart Association recommends reasonable strategies for hypertension prevention including maintenance of normal BMI, consuming a DASH-type diet, avoiding excessive sodium consumption, and regular vigorous physical activity 4
Multiple risk factors, including obesity and hypertension, may lead to greater increases in cardiovascular risk than explained by individual risk factors alone, suggesting the importance of comprehensive management 4
Important Caveats
Some studies suggest that after adjusting for related confounders, hypertensive disorders during pregnancy may not exert a significant independent effect on childhood overweight/obesity risk 6
The relationship between maternal hypertension and childhood obesity appears to be complex and may involve shared genetic factors, intrauterine programming, and postnatal environmental influences 1, 2
The strength of the association may vary with the specific type of hypertensive disorder (chronic hypertension vs. gestational hypertension vs. preeclampsia) and the timing during pregnancy 3, 2