Wang Hongjian, Mueller Noel T, Li Jianping, Sun Ninglin, Huo Yong, Ren Fazheng, Wang Xiaobin
Department of Cardiovascular Internal Medicine, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Am J Hypertens. 2017 May 1;30(5):532-540. doi: 10.1093/ajh/hpx003.
The prevalence of childhood elevated blood pressure (BP) has increased in the United States, particularly among African Americans. The influence of maternal plasma folate levels, alone or in combination with maternal cardiometabolic risk factors (hypertensive disorders, diabetes, and prepregnancy obesity), on child systolic BP (SBP) has not been examined in a prospective birth cohort. We hypothesize that adequate maternal folate levels can reduce the risk of elevated SBP in children born to mothers with cardiometabolic risk factors.
This study included 1,290 mother-child dyads (875 African Americans (67.8%)) recruited at birth and followed prospectively up to age 9 years from 2003 to 2014 at the Boston Medical Center. Child SBP percentile was calculated according to US reference data and elevated SBP was defined as SBP ≥75th percentile.
Maternal folate levels, overall, were not associated with child SBP. However, we found a significant multiplicative interaction between maternal cardiometabolic risk factors and maternal folate levels (Pinteraction = 0.015) on childhood elevated SBP. Among children born to mothers with any cardiometabolic risk factors, those whose mothers had folate levels above (vs. below) the median had 40% lower odds of elevated childhood SBP (odds ratio = 0.60, 95% confidence interval: 0.40-0.90). The associations did not differ appreciably in analyses restricted to African Americans, and they were not explained by gestational age, size at birth, prenatal folate intake, or breastfeeding.
Findings from our urban minority birth cohort suggest that higher levels of maternal folate may help counteract the adverse associations of maternal cardiometabolic risk factors on child SBP.
在美国，儿童高血压患病率呈上升趋势，尤其是非裔美国人。母血叶酸水平单独或与母亲的心脏代谢危险因素（高血压疾病、糖尿病和孕前肥胖）相结合对儿童收缩压（SBP）的影响尚未在前瞻性出生队列中进行研究。我们假设，充足的母血叶酸水平可以降低患有心脏代谢危险因素的母亲所生孩子患收缩压升高的风险。
本研究纳入了2003年至2014年在波士顿医疗中心招募的1290对母婴二元组（875名非裔美国人（67.8%）），并对其进行了前瞻性随访，直至孩子9岁。根据美国参考数据计算儿童收缩压百分位数，收缩压升高定义为收缩压≥第75百分位数。
总体而言，母血叶酸水平与儿童收缩压无关。然而，我们发现母亲的心脏代谢危险因素与母血叶酸水平之间在儿童收缩压升高方面存在显著的相乘交互作用（交互P值 = 0.015）。在母亲患有任何心脏代谢危险因素的孩子中，母亲叶酸水平高于（vs.低于）中位数的孩子，其儿童收缩压升高的几率降低40%（优势比 = 0.60，95%置信区间：0.40 - 0.90）。在仅限于非裔美国人的分析中，这些关联没有明显差异，并且它们不受胎龄、出生时大小、产前叶酸摄入量或母乳喂养的影响。
我们城市少数族裔出生队列的研究结果表明，较高水平的母血叶酸可能有助于抵消母亲心脏代谢危险因素对儿童收缩压的不利影响。
