Foetoplacental factors predict hypertension in early childhood

Foetal growth deceleration and high foetoplacental vascular resistance both contribute to an increased risk of prehypertension and hypertension in children, a study has found.

A total of 693 mother‒offpsring dyads from the GUSTO prospective mother‒offspring cohort were recruited for this study. Prehypertension and hypertension at age 6 years were ascertained using the simplified paediatric threshold of 110/70 mm Hg.

Adjusting for sex, ethnicity, maternal education, and prepregnancy body mass index, the investigators then examined the associations of the following factors with the risk of prehypertension/hypertension at age 6 years: pregnancy complications (gestational diabetes, excessive/inadequate gestational weight gain, hypertensive disorders of pregnancy), foetal growth deceleration (decline in foetal abdominal circumference at least 0.67 standard deviations between second and third trimesters), high foetoplacental vascular resistance (third trimester umbilical artery systolic-to-diastolic ratio ≥90th centile), preterm birth, small-for-gestational age, and neonatal kidney volumes.

Pregnancy complications, small-for-gestational age, preterm birth, and low neonatal kidney volume showed no significant association with a higher risk of prehypertension/hypertension at age 6 years.

On the other hand, foetal growth deceleration correlated with a 72-percent increased risk (risk ratio [RR], 1.72, 95 percent confidence interval [CI], 1.18‒2.52) of prehypertension/hypertension in children, while a high foetoplacental vascular resistance correlated with a 58-percent increased risk (RR, 1.58, 95 percent CI, 0.96‒2.62).

Furthermore, having these two characteristics, compared with having neither, resulted in more than twofold higher risk (RR, 2.55, 95 percent CI, 1.26‒5.16). Greater than 85 percent of the foetuses with either of these characteristics were born appropriate or large for gestational age.

“Foetal growth deceleration and high foetoplacental vascular resistance may be helpful in prioritizing high-risk children for regular blood pressure monitoring and preventive interventions, across the birthweight spectrum,” the investigators said.