In a finding that suggests heart health starts in the womb, a new study shows that the state of a woman's heart during pregnancy may predict her kids' health by the time they reach adolescence.
Researchers found that when mothers' weight, blood pressure and cholesterol levels were less healthy during pregnancy, their children were at heightened risk for those same issues.
The reasons are not certain, but it could be a matter of both biology and lifestyle, said lead researcher Dr. Amanda Perak. She's an assistant professor at Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, in Chicago.
Genes, as well as the effects of the uterine environment on fetal development, could be at work, Perak said. Plus, she added, kids' diets and exercise habits likely mirror their parents'.
Regardless of the reasons, Perak said the findings add to evidence that heart risk factors take shape early, and maybe even before birth.
Experts called the findings "important," by showing that pregnancy could be a critical time in determining future heart health.
"The health of moms during pregnancy could impact future generations," said Dr. Nisha Parikh, a cardiologist at the University of California, San Francisco, and a volunteer expert with the American Heart Association.
That's not to say anything is set in stone, Parikh stressed: If pregnant women are not in optimal cardiovascular health, their kids still can be, with the help of a healthy diet and exercise.
But ideally, Parikh said, women should go into pregnancy at a healthy weight, not smoking and with normal blood pressure, cholesterol and blood sugar levels.
The findings, published Feb. 16 in the Journal of the American Medical Association, are based on 2,300 mother-child pairs from several countries, including the United States. The researchers assessed mothers' cardiovascular risk factors during the 28th week of pregnancy, looking at their blood pressure, cholesterol, blood sugar, weight and smoking habits.
The investigators then assessed those same factors (minus smoking) in their children at the ages of 10 to 14.
Overall, one-third of pregnant women were deemed to have optimal cardiovascular health, while 6% had two or more risk factors. Years later, children born to moms in that latter group were nearly eight times more likely to have multiple risk factors, versus kids whose mothers had been in optimal health during pregnancy.
Those odds were three times higher among kids whose mothers had one risk factor.
Dr. Stephen Daniels, who wrote an editorial accompanying the report, said that he thinks the study is "really important."
At one time, it was thought that all babies start off with a "clean slate" in terms of cardiovascular health, said Daniels, pediatrician-in-chief at Children's Hospital Colorado, in Aurora.
But in more recent years, research has been indicating that exposures in the womb may set children up with varying levels of cardiovascular health at birth, he noted.
Like Parikh, Daniels said that does not mean kids' health is predetermined. And, he added, "this is not about blaming mothers."
Instead, it's possible that helping women go into pregnancy as healthy as possible could have ripple effects for their children, Daniels said. And if more teenagers were in optimal cardiovascular health, that could translate into fewer heart attacks and strokes years later.
In a study last year, Perak and her colleagues found evidence of that.
People who were in good cardiovascular health in their late teens had very low rates of premature heart disease or stroke over the next 32 years. And their odds of those ills were about 85% lower, versus young people who already had risk factors like elevated blood pressure, cholesterol or blood sugar.
Daniels pointed to other research showing that if people make it to age 50 free of major risk factors like high blood pressure and diabetes, they have a very low lifetime risk of heart disease or stroke.
"The problem is, not many people do reach age 50 with no risk factors," Daniels said.
So prevention has to start early, possibly even in the womb.
"Mothers' health during pregnancy may be even more important than we've appreciated," Daniels said.
Perak encouraged women who are pregnant or planning a pregnancy to talk to their doctor about how to "optimize" their diet, exercise and sleep habits, and get help with quitting smoking if needed.
The U.S. Department of Health and Human Services has advice on staying healthy during pregnancy.
SOURCES: Amanda Perak, MD, MS, assistant professor, pediatrics and preventive medicine, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago; Stephen Daniels, MD, PhD, professor, pediatrics, University of Colorado School of Medicine, and pediatrician-in-chief, Children's Hospital Colorado, Aurora; Nisha Parikh, MD, MPH, associate professor, medicine, University of California, San Francisco, and volunteer expert, American Heart Association, Dallas; Journal of the American Medical Association, Feb. 16, 2021