Vascular health in pregnancy; maternal and child outcomes : The Generation R study

The overall aim of this thesis was to investigate the role of angiogenic factors, micronutrients involved in the homocysteine metabolism, and maternal blood pressure, in relation to maternal and child health during and after pregnancy. The questions to be addressed in this thesis are: _Part I: Maternal health_ 1) Do homocysteine, folate and vitamin B12 concentrations affect placental development and subsequently maternal and child health during pregnancy? 2) To what extent do maternal gestational blood pressure and hypertensive pregnancy disorders influence maternal cardiometabolic outcomes six years after delivery? _Part II: Child health_ 3) How do early pregnancy and umbilical cord blood markers of the homocysteine pathway and angiogenic markers relate to fetal and childhood growth? 4) Is maternal blood pressure associated with childhood blood pressure

Associations of maternal and paternal blood pressure patterns and hypertensive disorders during pregnancy with childhood blood pressure

Background-Hypertensive disorders in pregnancy may affect the cardiovascular risk of offspring. We examined the associations of maternal blood pressure throughout pregnancy and hypertensive disorders in pregnancy with childhood blood pressure of offspring. Specific focus was on the comparison with paternal blood pressure effects, the identification of critical periods, and the role of birth outcomes and childhood body mass index in the observed associations. Methods and Results-This study was embedded in a population-based prospective cohort study among 5310 mothers and fathers and their children. We measured maternal blood pressure in each trimester of pregnancy and paternal blood pressure once. Information about hypertensive disorders in pregnancy was obtained from medical records. We measured childhood blood pressure at the median age of 6.0 years (95% range 5.7-8.0 years). Both maternal and paternal blood pressure were positively associated with childhood blood pressure (all P < 0.05), with similar effect estimates. Conditional regression analyses showed that early, mid-, and late-pregnancy maternal blood pressure levels were all independent and positively associated with childhood blood pressure, with the strongest effect estimates for early pregnancy. Compared with children of mothers without hypertensive disorders in pregnancy, children of mothers with hypertensive disorders in pregnancy had higher diastolic blood pressure by a standard deviation score of 0.13 (95% CI 0.05-0.21). The observed associations were not materially affected by birth outcomes and childhood body mass index. Conclusions-Both maternal and paternal blood pressure affects childhood blood pressure, independent of fetal and childhood growth measures, with the strongest effect of maternal blood pressure in early pregnancy