CMHC Pulse Blog

Endocrine-Metabolic Consequences of Chronic Maternal Hypertension

Maternal hypertension and hypertensive disorders during pregnancy have been proven to significantly increase the risk of perinatal health complications in both mothers and their offspring. Conditions such as chronic hypertension, gestational hypertension, preeclampsia, and eclampsia are common and complicate between 5 and 10% of pregnancies, leading to maternal mortality, stillbirth, and preterm birth as well as often predicting cardiovascular morbidity in both the mother and child.

Published in Childhood Obesity, the results of a recent trial reveal that babies born to mothers with diagnosed chronic hypertension face a significantly higher likelihood of developing endocrine-metabolic morbidities by the age of 18 and are more likely to be obese during childhood.

Chronic Maternal Hypertension and Endocrine-Metabolic Morbidity

A team of researchers aimed to determine whether chronic maternal hypertension has an impact on long-term pediatric endocrine and metabolic morbidity. The investigators conducted a population-based, retrospective cohort study including data from all women who gave birth at the Soroka University Medical Center in Israel between 1991 and 2014.

Trial participants were screened for hypertension before pregnancy or during pregnancy before 20 weeks gestation. Women with a documented history of chronic hypertension were included in the hypertensive cohort regardless of antihypertensive medication use. Data excluded from the study included that from women with multiple gestations, fetuses with congenital malformations, and women diagnosed with other pregnancy-related hypertensive disorders.

In total, 232,841 singleton deliveries met data inclusion criteria of which 1.1% or 2,655 deliveries were by mothers with chronic hypertension.

Compared to women in the control group, participants in the hypertensive group had a higher mean maternal age  – 32.6 versus 28.1 years – a higher likelihood of having had over 5 deliveries, a 5 times greater incidence of gestational diabetes, as well as an increased likelihood of preterm delivery.

Elevated Risk in Offspring 

Researchers evaluated the children of mothers included in the study for endocrine and metabolic morbidities during hospitalizations up to the age of 18 at SUMC. The team recorded a total of 1,085 offspring hospitalizations involving endocrine and metabolic morbidity up to 18 years of age. Hospitalization rates were doubled in the hypertensive cohort compared with those in the normotensive control group. In addition, childhood obesity rates were significantly higher in children of hypertensive mothers at 0.7% versus 0.2%.

Using Cox proportional hazards models to control for gestational age at birth, maternal diabetes mellitus, and maternal obesity, the study’s authors demonstrated the link between endocrine-related hospitalizations and maternal chronic hypertension. Their findings revealed that exposure to maternal chronic hypertension is a significant, independent risk factor for offspring endocrine and metabolic morbidity; the association remained true in several analyses of other variables – including ethnicity, year of birth, cesarean delivery, and neonatal birth weight.

“To the best of our knowledge, this is the first study to evaluate the impact of maternal chronic hypertensive disorders during pregnancy on the incidence of endocrine and metabolic morbidity of the offspring,” the study authors said. “Although intuitive, it is yet to be determined whether optimal treatment and surveillance in pregnancies involving chronic hypertension will positively impact not only perinatal outcome but also alter offspring health.”

As the risk of health complications in cases of chronic maternal hypertension extends to children not only during the perinatal phase but for many years after birth, it is important to continue and improve management methods in hypertensive women. These new findings may provide an added factor for consideration in childhood obesity prevention and predict endocrine-metabolic morbidities prior to their development.

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