Maternal smoking: a life course blood pressure determinant?

Introduction: Exposure to maternal smoking early in life may affect blood pressure (BP) control mechanisms. We examined the association between maternal smoking (before conception, during pregnancy, and 4 years after delivery) and BP in preschool children. Methods: We evaluated 4295 of Generation XXI children, recruited at birth in 2005–2006 and reevaluated at the age of 4. At birth, information was collected by face-to-face interview and additionally abstracted from clinical records. At 4-year follow-up, interviews were performed and children’s BP measured. Linear regression models were fitted to estimate the association between maternal smoking and children’s BP. Results: Children of smoking mothers presented significantly higher BP levels. After adjustment for maternal education, gestational hypertensive disorders, and child’s body mass index, children exposed during pregnancy to maternal smoking presented a higher systolic BP (SBP) z-score (β = 0.08, 95% confidence interval [CI] 0.04 to 0.14). In crude models, maternal smoking was associated with higher SBP z-score at every assessed period. However, after adjustment, an attenuation of the association estimates occurred (β = 0.08, 95% CI 0.03 to 0.13 before conception; β = 0.07, 95%CI 0.02 to 0.12; β = 0.04, 95%CI −0.02 to 0.10; and β = 0.06, 95%CI 0.00 to 0.13 for the first, second, and third pregnancy trimesters, respectively; and β = 0.07, 95%CI 0.02 to 0.12 for current maternal smoking). No significant association was observed for diastolic BP z-score levels. Conclusion: Maternal smoking before, during, and after pregnancy was independently associated with systolic BP z-score in preschool children. This study provides additional evidence to the public health relevance of maternal smoking cessation programs if early cardiovascular health of children is envisaged. Implications: Using observational longitudinal data from the birth cohort Generation XXI, this study showed that exposure to maternal smoking—before pregnancy, during pregnancy, and 4 years after delivery—was associated with a systolic BP-raising effect in children at the age of 4. The findings of this study add an important insight into the need to support maternal smoke-free environments in order to provide long-term cardiovascular benefit, starting as early as possible in life.Generation XXI has been funded by the Operational Health Programme XXI Health, Community support framework III (co-funded by Feder), Administração Regional de Saúde do Norte, Fundação Calouste Gulbenkian and Fundação para a Ciência e Tecnologia (SFRH/BSAB/113778/2015; PD/BD/105824/2014; PD/BD/105827/2014; F-COMP-01-0124-FEDER-011008; FCT—PTDC/SAU-ESA/105033/2008). Also, the Portuguese Foundation for Science and Technology funds the Epidemiology Research Unit of the Institute of Public Health of the University of Porto (UID/DTP/04750/2013). This article is a result of the project DOCnet (NORTE-01-0145-FEDER-000003), supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF)

Prenatal Stress and Balance of the Child's Cardiac Autonomic Nervous System at Age 5-6 Years

Objective: Autonomic nervous system (ANS) misbalance is a potential causal factor in the development of cardiovascular disease. The ANS may be programmed during pregnancy due to various maternal factors. Our aim is to study maternal prenatal psychosocial stress as a potential disruptor of cardiac ANS balance in the child. Methods: Mothers from a prospective birth cohort (ABCD study) filled out a questionnaire at gestational week 16 [IQR 12– 20], that included validated instruments for state anxiety, depressive symptoms, pregnancy-related anxiety, parenting daily hassles and job strain. A cumulative stress score was also calculated (based on 80 th percentiles). Indicators of cardiac ANS in the offspring at age 5–6 years are: pre-ejection period (PEP), heart rate (HR), respiratory sinus arrhythmia (RSA) and cardiac autonomic balance (CAB), measured with electrocardiography and impedance cardiography in resting supine and sitting positions. Results: 2,624 mother-child pairs, only single births, were available for analysis. The stress scales were not significantly associated with HR, PEP, RSA and CAB (p$0.17). Accumulation of maternal stress was also not associated with HR, PEP, RSA and CAB (p$0.07). Conclusion: Results did not support the hypothesis that prenatal maternal psychosocial stress deregulates cardiac AN

Blood Pressure in 6-Year-Old Children Born Extremely Preterm

Background-Advances in perinatal medicine have increased infant survival after very preterm birth. Although this progress is welcome, there is increasing concern that preterm birth is an emerging risk factor for hypertension at young age, with implications for the lifetime risk of cardiovascular disease. Methods and Results-We measured casual blood pressures (BPs) in a population-based cohort of 6-year-old survivors of extremely preterm birth (<27 gestational weeks; n=171) and in age-and sex-matched controls born at term (n=172). Measured BP did not differ, but sex, age-, and height-adjusted median z scores were 0.14 SD higher (P=0.02) for systolic BP and 0.10 SD higher (P=0.01) for diastolic BP in children born extremely preterm than in controls. Among children born extremely preterm, shorter gestation, higher body mass index, and higher heart rate at follow-up were all independently associated with higher BP at 6 years of age, whereas preeclampsia, smoking in pregnancy, neonatal morbidity, and perinatal corticosteroid therapy were not. In multivariate regression analyses, systolic BP decreased by 0.10 SD (P=0.08) and diastolic BP by 0.09 SD (P=0.02) for each week-longer gestation. Conclusions-Six-year-old children born extremely preterm have normal but slightly higher BP than their peers born at term. Although this finding is reassuring for children born preterm and their families, follow-up at older age is warranted.Peer reviewe

Cardiovascular and metabolic influences of fetal smoke exposure

Many epidemiological studies showed associations of low birth weight with cardiovascular disease, type 2 diabetes and obesity. The associations seem to be consistent and stronger among subjects with a postnatal catch up growth. It has been suggested that developmental changes in response to adverse fetal exposures might lead to changes in the fetal anatomy and physiology. These adaptations may be beneficial for short term, but may lead to common diseases in adulthood. Maternal smoking during pregnancy is one of the most important adverse fetal exposures in Western countries, and is known to be associated with a 150–200 g lower birth weight. An accumulating body of evidence suggests that maternal smoking during pregnancy might be involved in pathways leading to both low birth weight and common diseases, including cardiovascular disease, type 2 diabetes and obesity, in adulthood. In this review, we discuss epidemiological studies focused on the associations of maternal smoking with fetal growth and development and cardiovascular and metabolic disease in later life. We also discuss potential biological mechanisms, and challenges for future epidemiological studies

Preterm‐born individuals: a vulnerable population at risk of cardiovascular morbidity and mortality during thermal extremes?

New Findings: What is the topic of this review? Thermal extremes disproportionately affect populations with cardiovascular conditions. Preterm birth, across all gestational age ranges below 37 weeks, has been identified as a non‐modifiable risk factor for cardiovascular disease. The hypothesis is presented that individuals born preterm are at an increased risk of cardiovascular morbidity and mortality during thermal extremes. What advances does it highlight? Cardiovascular stress tests performed in preterm‐born populations, from infancy through adulthood, highlight a progression of cardiovascular dysfunction accelerating through adolescence and adulthood. This dysfunction has many similarities with populations known to be at risk in thermal extremes. Abstract: Preterm‐born individuals are a uniquely vulnerable population. Preterm exposure to the extrauterine environment and the (mal)adaptations that occur during the transitional period can result in alterations to their macro‐ and micro‐physiological state. The physiological adaptations that increase survival in the short term may place those born preterm on a trajectory of lifelong dysfunction and later‐life decompensation. Cardiovascular compensation in children and adolescents, which masks this trajectory of dysfunction, is overcome under stress, such that the functional cardiovascular capacity is reduced and recovery impaired following physiological stress. This has implications for their response to thermal stress. As the Anthropocene introduces greater changes in our environment, thermal extremes will impact vulnerable populations as yet unidentified in the climate change context. Here, we present the hypothesis that individuals born preterm are a vulnerable population at an increased risk of cardiovascular morbidity and mortality during thermal extremes

Pediatrics

BACKGROUND AND OBJECTIVESImmediately after the 1994 Back-to-Sleep campaign, sudden unexpected infant death (SUID) rates decreased dramatically, but they have remained relatively stable (93.4 per 100 000 live births) since 2000. In this study, we examined trends in SUID rates and disparities by race/ethnicity since the Back-to-Sleep campaign.METHODSWe used 1995\u20132013 US period-linked birth-infant death data to evaluate SUID rates per 100 000 live births by non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander racial/ethnic groupings. To examine racial/ethnic disparities, we calculated rate ratios with NHWs as the referent group. Unadjusted linear regression was used to evaluate trends (P < .05) in rates and rate ratios. The distribution and rates of SUID by demographic and birth characteristics were compared for 1995\u20131997 and 2011\u20132013, and \u3c72 tests were used to evaluate significance.RESULTSFrom 1995 to 2013, SUID rates were consistently highest for American Indian/Alaska Natives, followed by NHBs. The rate for NHBs decreased significantly, whereas the rate for NHWs also declined, but not significantly. As a result, the disparity between NHWs and NHBs narrowed slightly. The SUID rates for Hispanics and Asian/Pacific Islanders were lower than the rates for NHWs and showed a significant decrease, resulting in an increase in their advantage over NHWs.CONCLUSIONSEach racial/ethnic group showed a unique trend in SUID rates since the Back-to-Sleep campaign. When implementing risk-reduction strategies, it is important to consider these trends in targeting populations for prevention and developing culturally appropriate approaches for racial/ethnic communities.CC999999/Intramural CDC HHS/United States2018-06-01T00:00:00Z28562272PMC556146

In Utero Exposure to Maternal Tobacco Smoke and Subsequent Obesity, Hypertension, and Gestational Diabetes Among Women in The MoBa Cohort

Background: Environmental factors influencing the developmental origins of health and disease need to be identified and investigated. In utero exposure to tobacco smoke has been associated with obesity and a small increase in blood pressure in children; however, whether there is a corresponding increased risk of conditions such as diabetes and hypertension during adulthood remains unclear

Effetto della prematurit&#224; sulla distribuzione della massa grassa e sulla pressione arteriosa in et&#224; prepubere: studio di follow-up

Obiettivi: valutare possibili alterazioni della composizione corporea e della pressione arteriosa in una coorte di ex-pretermine a 5 anni di et\ue0. Metodi: studio osservazionale longitudinale, esplorativo. Quaranta neonati pretermine venivano sottoposti a valutazione antropometrica e della composizione corporea tramite pletismografo ad aria a 40 settimane di et\ue0 corretta e a 5 anni. A 5 anni venivano inoltre misurate pressione arteriosa e pliche cutanee e calcolato il BMI. Criteri di inclusione per i neonati prematuri: peso inferiore a 1500 g, et\ue0 gestazionale alla nascita inferiore a 32 settimane. Criteri di esclusione: anomalie congenite/cromosomiche e patologie chirurgiche. Quarantatre neonati sani a termine costituivano il gruppo di riferimento. Risultati: al presunto termine, i nati prematuri presentavano peso e lunghezza inferiori ai controlli (18.328\ub13.01 vs 20.302\ub13.01 g; p=0.008 e 109.7\ub16.5 vs 112.7\ub14.3 cm; p=0.02, rispettivamente), mentre non venivano rilevate differenze nella percentuale di massa grassa. Le pliche addominale, sottoscapolare e sacroilaca (mm) risultavano maggiori nei bambini nati prematuri rispetto ai controlli (6.9\ub13.6 vs 5.3\ub12.8, p=0.002; 6,5\ub12,8 vs 5.0\ub11.6, p=0,01 e 11.8\ub14.3 vs 9.3\ub13.8, p=0,01, rispettivamente). I nati prematuri presentavano inoltre valori maggiori di pressione diastolica (62.2 vs 57.5 mmHg, p=0.01). Conclusioni: In et\ue0 prepubere, i bambini prematuri presentavano maggiore adiposit\ue0 truncale e pressione diastolica pi\uf9 elevata, con possibili effetti negativi sulla salute a distanzaPreterm infants may develop altered adiposity, a risk factor for metabolic syndrome. The aim was to evaluate if body composition and blood pressure were altered in a cohort of children born preterm followed up to prepubertal age. Observational, longitudinal, explorative study. Forty children born preterm underwent growth and body composition assessment by an air displacement plethysmography system at term c.a. and at 5 years. BMI, skinfold thicknesses and blood pressure were further measured at 5 years. Inclusion criteria were birth weight &lt;1500 g and gestational age &lt;32 weeks. Exclusion criteria were congenital/chromosomal or surgical diseases. Forty-three healthy children born at term were the reference group. At term c.a. preterm children were lighter (2455 +/- 484 g vs 3247 +/- 345 g; p&lt;0.001) and shorter (45.6 +/- 3.4 cm vs 49.1 +/- 2.3 cm; p&lt;0.001) than children born at term and their fat mass was higher (14.8% vs 8.6%; p=0.02). At 5 years of life, weight and height of children born preterm were lower than those of their counterpart (18.328 +/- 3.01 vs 20.302 +/- 3.01 g; p=0.008 and 109.7 +/- 6.5 vs 112.7 +/- 4.3 cm; p=0.02, respectively). No difference in percentage of fat mass was detected. Abdominal, subscapular and suprailiac skinfolds (mm) were larger in the preterm group (6.9 +/- 3.6 vs 5.3 +/- 2.8, p=0.002; 6.5 +/- 2.8 vs 5.0 +/- 1.6, p=0,01 and 11.8 +/- 4.3 vs 9.3 +/- 3.8, p=0,01, respectively). Diastolic pressure (mmHg) was higher in the preterm group (62.2 vs 57.5, p=0.01). At prepubertal age children born preterm tend towards a greater truncal adiposity and increased values of diastolic pressure which might have adverse consequences for later health