3 Maternal Risk Factors Linked to Elevated Offspring Blood Pressure

Three common maternal cardiometabolic risk factors arising during pregnancy were associated with increased systolic and diastolic blood pressure in offspring, according to a study published in JAMA Network Open.1

Researchers specifically looked at cases of prepregnancy obesity, gestational diabetes, and hypertensive disorders of pregnancy (HDP). For mothers with these risk factors, their offspring had a 4.88–percentile point higher systolic blood pressure (95% CI, 3.97-5.82) and a 1.90–percentile point higher diastolic blood pressure (95% CI, 1.15-2.64) at their first blood pressure measurement compared with those born to mothers without these risk factors.

The study also showed an even stronger association among female and Black offspring compared with offspring who are male or of another race. This is especially concerning as Black women are already known to be at a disproportionate risk for several conditions such as cardiovascular disease, hypertension, obesity, diabetes, and certain cancers.2 Recent CDC data showed that maternal cardiac death doubled in the US over the past 2 decades, with Black women facing triple the risk of death compared with White women, and mothers in the South having twice the mortality rate of those in the West.3

“These findings suggest that protecting pregnant individuals from cardiometabolic risk factors may promote healthier blood pressure in the next generation,” the study authors said.1

These health effects can follow children through their adolescence. | Image credit: romaset – stock.adobe.com

The cohort study included more than 12,000 mother-offspring pairs, with about 52% of pairs identifying as White, 19% as Hispanic, 16% as Black, 7% as Asian, and 6% as another race or ethnicity. The mean (SD) maternal age at pregnancy was 29.9 (6.4) years, and about 44% of mothers presented with 1 or more cardiometabolic risk factor. Prepregnancy obesity was the most prevalent, affecting about a quarter of pregnant mothers, followed by HDP (13.6%) and gestational diabetes (6.5%). Data were gathered from the Environmental Influences on Child Health Outcomes program.

HDP had the strongest association with higher offspring blood pressure both alone and in combination with either of the other risk factors. The biggest change in systolic blood pressure was seen among mothers with both HDP and prepregnancy diabetes (adjusted β, 7.31; 95% CI, 4.99-9.62), followed by HDP and gestational diabetes (adjusted β, 6.19; 95% CI, 0.24-12.14). This was flipped for diastolic blood pressure, with combination HDP and gestational diabetes having a stronger association with change (adjusted β, 5.03; 95% CI, 0.30-9.75) than HDP and prepregnancy obesity (adjusted β, 3.61; 95% CI, 1.77-5.46). Gestational diabetes alone had no association with offspring diastolic blood pressure.

Among the 116 mothers with all 3 risk factors, the combination was associated with an increased systolic (adjusted β, 3.41; 95% CI, −1.37 to 8.19) and diastolic (adjusted β, 0.00; 95% CI, −2.12 to 2.10) blood pressure in their offspring, but the difference was not statistically significant.

Black children are at the highest risk of increased blood pressure based on these findings. Compared with White offspring, Black offspring were more likely to have a higher systolic blood pressure if their mother had gestational diabetes (adjusted β, 7.60 vs 0.63; P for interaction = .01) or HDP (adjusted β, 7.48 vs 3.42; P for interaction = .01). On the other hand, there was a stronger association with systolic blood pressure and gestational diabetes among White offspring (adjusted β, 4.83), but it also affected Black (adjusted β, 3.66), Hispanic (adjusted β, 3.03), and Asian offspring (adjusted β, 2.88; P for interaction = .03).

Looking at all possible risk factor combinations, Black offspring typically had the highest systolic blood pressure percentiles, except for Asian offspring who were in a higher percentile for obesity alone. Asian children were also in the highest percentiles for diastolic blood pressure if their mothers had any cardiometabolic risk factors, obesity, and HDP. However, diastolic blood pressure percentiles for gestational diabetes alone, HDP with either obesity or gestational diabetes, or all 3 combined were highest among Black offspring.

“Importantly, previous studies found that the associations between maternal cardiometabolic risk factors and high offspring blood pressure were independent of familial and individual adiposity, thus collectively suggesting a possible direct programming effect of intrauterine exposure to HDP and/or gestational diabetes on offspring blood pressure,” the authors noted. “If such a programming effect is causal, achieving a healthier cardiometabolic profile in the childbearing population would be essential to improve cardiovascular health in future generations.”

These effects can also follow children through their adolescence. Of the 6015 offspring who had their blood pressure taken twice or more, these risk factors were tied to an increased rate of blood pressure change from age 2 to 18 years, with a 0.5 percentile change in systolic blood pressure (95% CI, 0.2-0.8) and a 0.7 percentile change in diastolic blood pressure (95% CI, 0.5-1.0) each year.

While the study had a large, diverse population, assessed different combinations of risk factors, and used longitudinal analyses to measure changes in blood pressure, the findings still have some limitations that warrant further research. The researchers did not look deeper into HDP subtypes, meaning there could be minor differences in association based on subtype that haven’t been found yet. They also relied on body mass index to define prepregnancy obesity and did not have data on gestational weight gain, diet, or physical activity, leaving out important individual health information that could provide more context.

References

1. Niu Z, Ako AA, Geiger SD, et al. Maternal cardiometabolic risk factors in pregnancy and offspring blood pressure at age 2 to 18 years. JAMA Netw Open. 2025;8(5):e259205. doi:10.1001/jamanetworkopen.2025.9205
2. Chinn JJ, Martin IK, Redmond N. Health equity among Black women in the United States. J Womens Health (Larchmt). 2021;30(2):212-219. doi:10.1089/jwh.2020.8868\
3. Klein HE. Maternal cardiac deaths double, impacting Black women most. AJMC®. March 25, 2025. Accessed May 13, 2025. https://www.ajmc.com/view/maternal-cardiac-deaths-double-impacting-black-women-most