Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Am J Epidemiol. 2019 Nov 1;188(11):1913-1922. doi: 10.1093/aje/kwz181.
Childhood blood pressure (BP) is a strong predictor of later risk of cardiovascular disease. However, few studies have assessed dynamic BP trajectories throughout the early-life period. We investigated the relationship between early-life factors and systolic BP (SBP) from infancy to adolescence using linear spline mixed-effects models among 1,370 children from Project Viva, a Boston, Massachusetts-area cohort recruited in 1999-2002. After adjusting for confounders and child height, we observed higher SBP in children exposed to gestational diabetes mellitus (vs. normoglycemia; age 3 years: β = 3.16 mm Hg (95% confidence interval (CI): 0.28, 6.04); age 6 years: β = 1.83 mm Hg (95% CI: 0.06, 3.60)), hypertensive disorders of pregnancy (vs. normal maternal BP; age 6 years: β = 1.39 mm Hg (95% CI: 0.10, 2.67); age 9 years: β = 1.84 mm Hg (95% CI: 0.34, 3.34); age 12 years: β = 1.70 mm Hg (95% CI: 0.48, 2.92)), higher neonatal SBP (per 10-mm Hg increase; age 3 years: β = 1.26 mm Hg (95% CI: 0.42, 2.09); age 6 years: β = 1.00 mm Hg (95% CI: 0.49, 1.51); age 9 years: β = 0.75 mm Hg (95% CI: 0.17, 1.33)), and formula milk in the first 6 months of life (vs. breast milk only; age 12 years: β = 2.10 mm Hg (95% CI: 0.46, 3.74); age 15 years: β = 3.52 mm Hg (95% CI: 1.40, 5.64); age 18 years: β = 4.94 mm Hg (95% CI: 1.88, 7.99)). Our findings provide evidence of programming of offspring SBP trajectories by gestational diabetes, hypertensive disorders of pregnancy, and formula milk intake and of neonatal BP being a potentially useful marker of childhood BP. These factors could be relevant in identifying children who are at risk of developing elevated BP.
儿童期血压（BP）是心血管疾病发生风险的重要预测因素。然而，很少有研究评估整个生命早期动态 BP 轨迹。我们在 1999-2002 年波士顿地区队列研究的 Viva 项目中，使用线性样条混合效应模型，在 1370 名儿童中调查了生命早期因素与婴儿期至青春期期间收缩压（SBP）的关系。在调整混杂因素和儿童身高后，我们观察到暴露于妊娠期糖尿病（与正常血糖相比；3 岁时：β=3.16mmHg（95%置信区间（CI）：0.28，6.04）；6 岁时：β=1.83mmHg（95%CI：0.06，3.60））、妊娠高血压疾病（与母亲正常血压相比；6 岁时：β=1.39mmHg（95%CI：0.10，2.67）；9 岁时：β=1.84mmHg（95%CI：0.34，3.34）；12 岁时：β=1.70mmHg（95%CI：0.48，2.92））、新生儿 SBP 升高（每增加 10mmHg；3 岁时：β=1.26mmHg（95%CI：0.42，2.09）；6 岁时：β=1.00mmHg（95%CI：0.49，1.51）；9 岁时：β=0.75mmHg（95%CI：0.17，1.33））、6 个月内配方奶（与仅母乳喂养相比；12 岁时：β=2.10mmHg（95%CI：0.46，3.74）；15 岁时：β=3.52mmHg（95%CI：1.40，5.64）；18 岁时：β=4.94mmHg（95%CI：1.88，7.99））与子女 SBP 轨迹相关。我们的研究结果提供了妊娠期糖尿病、妊娠高血压疾病和配方奶摄入对后代 SBP 轨迹产生编程作用的证据，以及新生儿血压可能是儿童期血压的有用标志物的证据。这些因素可能与识别有发生高血压风险的儿童有关。
