Early childhood blood pressure trajectories in very low birth weight offspring: is there a legacy of maternal hypertension?

TL;DR

This study examines whether maternal hypertension during pregnancy affects blood pressure in children born with very low birth weight, finding only modest and non-significant associations.

Contribution

The study provides new insights into the long-term cardiovascular effects of maternal hypertensive disorders in very low birth weight children.

Findings

Maternal hypertensive disorders were not significantly associated with systolic or diastolic blood pressure in preterm children.

Blood pressure percentiles declined with age, suggesting a relative downward shift over time.

The cardiovascular effects of prenatal hypertensive exposure may be subtle or delayed.

Abstract

To investigate the association between maternal hypertensive disorders of pregnancy (HDP) and blood pressure (BP) in preterm children born with very low birth weight (VLBW, < 1500 g).

Longitudinal cohort study of VLBW preterm infants from birth to early childhood. Systolic and diastolic blood pressure (SBP and DBP), and their age-, height- and sex-adjusted percentiles (SBP%, DBP%), were assessed at multiple time points. Linear quantile mixed models estimated BP trajectories across the 25th, 50th, and 75th quantiles, stratified by maternal HDP exposure.

Among 277 infants, 121 (43.6 %) were exposed to HDP. Median gestational age was 30 weeks (IQR: 28 - 32), and median birth weight was 1180 g (IQR: 985, 1340), 128 (46.2 %) were male. Maternal HDP was not significantly associated with SBP or DBP at any quantile. BP increased modestly with age across all quantiles. SBP increased by 0.06, 1.55, and 2.58 mmHg; DBP by 1.77, 1.80, and 3.06 mmHg at the 25th, 50th, and 75th quantiles, respectively. Conversely, SBP% and DBP% declined with age, indicating a relative downward shift in BP percentiles over time. This decline was more pronounced for DBP%, especially in the lower quantiles.

In this cohort of VLBW preterm children, maternal HDP was associated with modest differences in blood pressure, though not statistically significant. These findings suggest that the cardiovascular effects of prenatal hypertensive exposure may be delayed, subtle, or modulated by postnatal factors. Long-term follow-up is essential to clarify these trajectories and guide early prevention efforts.

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