Cardiovascular disease (CVD) is a major cause of death in the U.S., and risk factors like high BMI, blood pressure, and cholesterol in early childhood are linked to CVD-related mortality in adulthood.
The American Heart Association’s Life’s Essential 8 (LE8) framework, which scores CVH on an integrated scale of behavioural and biological factors, shows that few U.S. children achieve optimal CVH. Evidence suggests CVH begins to decline around age 10, highlighting the importance of early prevention—even before birth. Studies have linked prenatal exposures (e.g., maternal obesity, gestational diabetes, smoking, and feeding practices) to poor CVH indicators in offspring. However, less is known about how these factors influence CVH trajectories throughout childhood and adolescence.
To fill this gap, researchers used a pre-birth cohort in Massachusetts to investigate whether prenatal and perinatal risk factors are associated with lower CVH and steeper declines from childhood through adolescence.
This study used data from the Project Viva prebirth cohort collected between April 1999 and August 2021. Participants were included if they had at least three CVH metrics in early childhood (median age 3.2 years) or at least four in mid-childhood (median age 7.7 years), early adolescence (median age 13.0 years), or late adolescence (median age 17.5 years).
The main outcome measured was the CVH score, ranging from 0 to 100 points, calculated as the unweighted average of all available CVH metrics at each life stage.
Among 1,333 children (51% male; 71.9% non-Hispanic White), the average age when CVH began to decline was around 10.2 years for boys and 10.0 years for girls. Lower CVH from childhood to adolescence was associated with maternal prepregnancy overweight/obesity, prenatal smoking, and formula feeding in infancy, but not with gestational diabetes.
Prepregnancy obesity was linked to a later and slower CVH decline, while gestational hypertension or preeclampsia was associated with an earlier inflection point and a more rapid decline after it. Smoking during pregnancy was also linked to a later CVH inflection point.
This study found that maternal prepregnancy overweight/obesity, prenatal smoking, and formula feeding during the first six months of life were each associated with lower overall CVH in children from early childhood through adolescence. While some CVH trajectory changes (e.g., timing and rate of decline) differed by prenatal exposures, these differences were small. The findings align with previous studies showing similar associations, though this study adds novel insight by tracking CVH repeatedly over time and using the more sensitive Life’s Essential 8 (LE8) framework rather than the older Life’s Simple 7 (LS7).
Gestational diabetes was not associated with offspring CVH, likely due to treatment during pregnancy, while untreated isolated hyperglycaemia was linked to poorer CVH. Some results, like the association of prepregnancy obesity and smoking with slower CVH decline, were unexpected and difficult to interpret given the lack of comparable data. However, even small sustained CVH score differences (1–2 points) may carry significant long-term health risks, as a 1-point lower adolescent CVH score has been associated with a 20% higher risk of CVD and mortality.
The study also highlighted that overall CVH decline around age 10 was primarily driven by behavioural CVH, possibly due to increased child autonomy and lifestyle shifts during adolescence. Biological CVH reductions were more strongly linked to maternal obesity and prenatal smoking (via higher BMI and BP in offspring), while poorer behavioural CVH was tied to lack of breastfeeding (via poorer diet and sleep). Broader social and environmental factors may also underlie these associations, pointing to a need for further research in diverse populations and settings.
This study provides evidence that prenatal and perinatal risk factors—specifically prepregnancy obesity, smoking during pregnancy, and formula feeding in infancy—are linked to poorer cardiovascular health trajectories from early childhood to late adolescence. Since these factors are modifiable, future research should explore whether targeting them through behavioural interventions can improve or preserve CVH in children and reduce long-term cardiovascular risk.
Source: JAMA
Image Credit: iStock
