Aris Izzuddin M, Rifas-Shiman Sheryl L, de Ferranti Sarah D, Hivert Marie-France, Perng Wei
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2025 Apr 1;8(4):e257774. doi: 10.1001/jamanetworkopen.2025.7774.
The American Heart Association put forth the Life's Essential 8 construct to assess cardiovascular health (CVH) based on 8 biological and behavioral factors. Few studies have identified prenatal and perinatal factors of CVH trajectories across childhood and adolescence, life stages where disease precursors and health behaviors are established.
To examine associations of prenatal and perinatal factors with child CVH trajectory.
DESIGN, SETTING, AND PARTICIPANTS: Data from the Project Viva prebirth cohort from April 1999 to August 2021 were used. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Data were analyzed from April 1 to September 30, 2024.
Prenatal and perinatal factors.
CVH score (0-100 points), calculated as the unweighted average of all available CVH metrics at each life stage.
Among 1333 children included, 680 (51.0%) were male, 78 (5.9%) Hispanic, 181 (13.6%) non-Hispanic Black, and 959 (71.9%) non-Hispanic White. The estimated mean (SD) age of inflection when CVH started to decline was 10.2 (0.7) years for male children and 10.0 (0.6) years for female children. Prepregnancy overweight or obesity (vs healthy or underweight), smoking during pregnancy (vs never), and formula-feeding (vs breastfeeding) in the first 6 months were each associated with lower CVH from childhood to adolescence, but gestational diabetes (vs normal glucose tolerance) was not associated with CVH. Prepregnancy obesity was associated with later inflection (β = 0.1; 95% CI, 0.0 to 0.2 years) and slower CVH decline after inflection (β = 0.2; 95% CI, 0.1 to 0.4 points per year). Gestational hypertension or preeclampsia (vs normal blood pressure) was associated with faster CVH gain before inflection (β = 0.3; 95% CI, 0.1 to 0.5 points per year), earlier inflection (β = -0.1; 95% CI, -0.2 to 0.0 years), and faster CVH decline after inflection (β = -0.3; 95% CI, -0.5 to -0.1 points per year), while smoking during pregnancy was associated with later inflection (β = 0.2; 95% CI, 0.1 to 0.3 years).
In this cohort study, prepregnancy overweight or obesity, smoking during pregnancy, and formula-feeding in the first 6 months of life were each associated with adverse CVH trajectories early in life. Future work should examine whether interventions that address these factors would be effective in optimizing CVH in children.
美国心脏协会提出了“生命关键8要素”框架，基于8个生物和行为因素来评估心血管健康（CVH）。很少有研究确定贯穿儿童期和青少年期（疾病先兆和健康行为得以确立的生命阶段）的CVH轨迹的产前和围产期因素。
研究产前和围产期因素与儿童CVH轨迹之间的关联。
设计、背景和参与者：使用了1999年4月至2021年8月“活力项目”出生前队列的数据。纳入的参与者在幼儿期（中位年龄[范围]为3.2[2.8 - 6.2]岁）需要有3个或更多的CVH指标，或在童年中期（中位年龄[范围]为7.7[6.6 - 10.9]岁）、青春期早期（中位年龄[范围]为13.0[11.9 - 16.6]岁）或青春期晚期（中位年龄[范围]为17.5[15.4 - 20.1]岁）需要有4个或更多的CVH指标。数据于2024年4月1日至9月30日进行分析。
产前和围产期因素。
CVH评分（0 - 100分），计算方法为每个生命阶段所有可用CVH指标的未加权平均值。
在纳入的1333名儿童中，680名（51.0%）为男性，78名（5.9%）为西班牙裔，181名（13.6%）为非西班牙裔黑人，959名（71.9%）为非西班牙裔白人。CVH开始下降时的估计平均（标准差）拐点年龄，男性儿童为10.2（0.7）岁，女性儿童为10.0（0.6）岁。孕前超重或肥胖（与健康或体重过轻相比）、孕期吸烟（与从不吸烟相比）以及出生后前6个月配方奶喂养（与母乳喂养相比）均与儿童期至青少年期较低的CVH相关，但妊娠期糖尿病（与正常糖耐量相比）与CVH无关。孕前肥胖与更晚的拐点（β = 0.1；95%置信区间，0.0至0.2岁）以及拐点后CVH下降较慢（β = 0.2；95%置信区间，每年0.1至0.4分）相关。妊娠期高血压或先兆子痫（与正常血压相比）与拐点前更快的CVH增加（β = 0.3；95%置信区间，每年0.1至0.5分）、更早的拐点（β = -0.1；95%置信区间，-0.2至0.0岁）以及拐点后更快的CVH下降（β = -0.3；95%置信区间，-0.5至-0.1分）相关，而孕期吸烟与更晚的拐点（β = 0.2；95%置信区间，0.1至0.3岁）相关。
在这项队列研究中，孕前超重或肥胖、孕期吸烟以及出生后前6个月配方奶喂养均与生命早期不良的CVH轨迹相关。未来的研究应探讨针对这些因素的干预措施是否能有效优化儿童的CVH。
