Academic Medical Center, Department of Public Health, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
Hypertension. 2013 Sep;62(3):641-7. doi: 10.1161/HYPERTENSIONAHA.113.01511. Epub 2013 Jul 22.
Adverse intrauterine conditions can program hypertension. Because one of the underlying mechanisms is thought to be cardiac autonomic balance, we investigated the association between prepregnancy body mass index (BMI) and blood pressure and indicators of the autonomic balance in the child at age 5 to 6 years. Also investigated was whether these associations were mediated by standardized birth weight and child BMI. Pregnant women (n=3074) participating in the Amsterdam Born Children and their Development study completed a questionnaire at gestational week 14. At age 5 to 6 years, offspring's sympathetic drive (pre-ejection period), parasympathetic drive (respiratory sinus arrhythmia), and heart rate were measured by electrocardiography and impedance cardiography at rest. Blood pressure was assessed simultaneously. After adjusting for possible maternal/offspring confounders, prepregnancy BMI was positively linearly associated with diastolic blood pressure (β=0.11 mm Hg; 95% confidence interval, 0.05-0.17), systolic blood pressure (β=0.14 mm Hg; 95% confidence interval, 0.07-0.21), but not with heart rate, sympathetic or parasympathetic drive. After adding birth weight and child BMI to the model, the independent effect size of prepregnancy body mass index on systolic blood pressure (β=0.07 mm Hg; 95% confidence interval, 0.00-0.14) and diastolic blood pressure (β=0.07 mm Hg; 95% confidence interval, 0.01-0.13) decreased by ≈50%. Birth weight did not mediate these relationships, but was independently and negatively associated with blood pressure. Child BMI was positively associated with blood pressure and partly mediated the association between prepregnancy BMI and blood pressure. In conclusion, higher prepregnancy BMI is associated with higher blood pressure in the child (aged 5-6 years) but does not seem to be attributable to early alterations in resting cardiac autonomic balance. Child BMI, but not birth weight, mediated the association between prepregnancy BMI and blood pressure.
不良的宫内环境会导致高血压。由于潜在的机制之一被认为是心脏自主平衡，我们研究了孕妇孕前体重指数（BMI）与儿童 5 至 6 岁时血压和自主平衡指标之间的关系。还研究了这些关联是否通过标准化出生体重和儿童 BMI 来介导。参加阿姆斯特丹出生儿童及其发育研究的孕妇（n=3074）在妊娠 14 周时完成了一份问卷。在 5 至 6 岁时，通过心电图和阻抗心动图在休息时测量了后代的交感神经驱动（射血前期）、副交感神经驱动（呼吸窦性心律失常）和心率。同时评估了血压。在校正了可能的母亲/后代混杂因素后，孕前 BMI 与舒张压（β=0.11mmHg；95%置信区间，0.05-0.17）和收缩压（β=0.14mmHg；95%置信区间，0.07-0.21）呈正线性相关，但与心率、交感或副交感神经驱动无关。在将出生体重和儿童 BMI 添加到模型中后，孕前体重指数对收缩压（β=0.07mmHg；95%置信区间，0.00-0.14）和舒张压（β=0.07mmHg；95%置信区间，0.01-0.13）的独立效应大小降低了约 50%。出生体重不能介导这些关系，但与血压独立且呈负相关。儿童 BMI 与血压呈正相关，并部分介导了孕前 BMI 与血压之间的关系。总之，较高的孕前 BMI 与儿童（5-6 岁）的血压升高有关，但似乎与静息心脏自主平衡的早期改变无关。儿童 BMI，但不是出生体重，介导了孕前 BMI 与血压之间的关系。
