# Maternal cardiovascular health and offspring neurodevelopment within the first five years of life: a birth cohort study

## TL;DR

Better maternal cardiovascular health during pregnancy is linked to improved neurodevelopment in children up to age five, especially in girls.

## Contribution

This study is the first to examine combined maternal cardiovascular health metrics during pregnancy and their association with offspring neurodevelopment across multiple ages.

## Key findings

- Higher maternal cardiovascular health scores were associated with increased cognitive and language scores in children aged 2–3 years.
- Female offspring showed a greater benefit in visual space index scores with higher maternal cardiovascular health scores.
- Each one-point increase in maternal cardiovascular health reduced the risk of suboptimal development in the visual space domain for girls.

## Abstract

The first five years of life are sensitive periods for neurodevelopment. Poor maternal metrics of cardiovascular health may influence offspring neurodevelopment. Previous studies focused only on one or two metrics, or different time window. This study is aimed to investigate the effects of combined cardiovascular health metric exposure during pregnancy on the neurodevelopment of offspring during crucial periods.

A total of 1007 mother‒child pairs recruited from 2013 to 2016 from the Shanghai Birth Cohort were included. Five maternal cardiovascular health metrics at 28 weeks of gestation were collected. Offspring neurodevelopment at 2–3 years and 4–5 years was evaluated with the Bayley-III and Wechsler preschool and primary scale of intelligence, fourth edition (WPPSI-IV), respectively.

After adjusting for confounders, the scores for cognition and language at 2–3 years significantly increased by 1.63 [95% confidence interval (CI) 0.42–2.83, P = 0.008] and 0.84 (95% CI 0.005–1.67, P = 0.049) per one-point higher maternal cardiovascular health score, respectively. After false discovery rate adjustment, the associations were preserved in the cognitive domain. Similarly, each one-point higher maternal cardiovascular health score was associated with an increase of 0.92 (95% CI 0.16–1.68, P = 0.018) and 0.71 (95% CI 0.01–1.40, P = 0.047) in the visual space index and working memory index scores at 4–5 years, respectively, but with an false discovery rate-adjusted P > 0.05; in the sex-stratified analysis, the visual space index scores significantly increased (β = 1.47, 95% CI 0.38–2.56, P = 0.009), regardless of false discovery rate correction. In addition, each one-point higher maternal cardiovascular health score reduced the relative risk of suboptimal development in the visual space index domain by 0.83 (95% CI 0.70–0.99; P = 0.041) in female offspring despite the non-significant after false discovery rate adjustment.

Our study provides novel evidence that maternal cardiovascular health during pregnancy is associated with offspring neurodevelopment within the first five years of life and that female offspring appear to derive greater benefit from higher maternal cardiovascular health scores. The potential role of maternal cardiovascular health in identifying risk of neurodevelopmental delay in clinical practice needs to be further explored.

The online version contains supplementary material available at 10.1007/s12519-025-00969-5.