The influence of birthweight on arterial blood pressure of children

Longitudinal study of birthweight, blood pressure, and markers of arterial stiffness in children age six among the TIDES cohort

OBJECTIVE

Although some studies have observed an association between birthweight and cardiovascular disease in adulthood, fewer have investigated whether birthweight is linked to cardiovascular health in early childhood. This study assesses the association between birthweight and cardiovascular outcomes in children 6 years of age.

STUDY DESIGN

Birthweight, blood pressure (BP), and markers of arterial stiffness in children, including brachial artery distensibility and carotid-femoral pulse wave velocity (cfPWV), were obtained from 324 participants in The Infant Development and the Environment Study, a prospective multisite pregnancy cohort. Birthweight was converted into sex-specific birthweight-for-gestational-age (bw/ga) z -scores based on the INTERGROWTH-21st standard. Following 2017 American Academy of Pediatrics guidelines, SBP and DBP were transformed into sex, age, and height-specific z -scores. Associations between birthweight and cardiovascular outcomes were assessed using nested multivariable linear regression models among the overall and sex-stratified samples.

RESULTS

Among the overall sample, bw/ga z -score was positively associated with cfPWV [b = 0.11 m/s, 95% confidence interval (CI): 0.01 m/s, 0.21 m/s] in crude and adjusted models. No associations between birthweight and cardiovascular outcomes were detected among the sex-stratified analyses.

CONCLUSION

Overall, birthweight was not related to cardiovascular outcomes in children 6 years old. However, infants born with a higher birthweight may be at risk for higher cfPWV in childhood. Early intervention in pregnant people at risk of delivering high birthweight infants may be warranted if results are replicated.

Social Inequalities in Child Development: Analysis of Low-Birth-Weight Trends in Brazil, 2010-2020

INTRODUCTION

Low birth weight (LBW) is a global issue prevalent in low-income countries. Economic assessments of interventions to reduce this burden are crucial to guide health policies. However, there is a relative scarcity of research that illustrates the magnitude of LBW by country and region to support the design of public policies.

OBJECTIVE

This study aimed to analyze the temporal trend of fetal growth in newborns in Brazil between 2010 and 2020.

METHODS

A time series study was conducted using data from the Live Births Information System (SINASC), which is managed by the Department of Information and Informatics of the Unified Health System (DATASUS) of the Brazilian Ministry of Health. The Prais-Winsten linear model was applied to analyze the annual proportions of LBW. The annual percentage changes (APC) and their respective 95% confidence intervals (95%CI) were calculated. Prevalence rate averages of LBW were calculated and displayed on thematic maps to visualize the evolution dynamics in each Federation Unit (FU).

RESULTS

A total of 31,887,329 women from all Federative Units of Brazil were included in the study from 2010 to 2020. The Southeast region had the largest proportion of participants, with records from 2015 accounting for 9.5% of the total. Among the women in the study, 49.6% were between the ages of 20 and 29, and the majority (75.5%) had between 8 and 12 years of schooling. The newborns of these women were predominantly male (58.8%) and non-white (59.5%). The study found that there was a trend towards stabilization of increasing proportions of LBW in the North, Northeast, and Centre-West regions between 2010 and 2020. In Brazil and other regions, these tendencies remained stable.

CONCLUSION

To improve living conditions and reduce social inequalities and health inequities, public policies and actions are necessary. Strengthening the Unified Health System (SUS), income transfer programs, quota policies for vulnerable groups, and gender equality measures such as improving access to education for women and the labor sector are among the suggested approaches.

Factors Associated with Primary Hypertension in Pediatric Patients: An Up-to-Date

BACKGROUND

Arterial hypertension in children is considered a common alteration nowadays, mainly because obesity is a growing worldwide problem closely related to increased blood pressure. Childhood hypertension can be classified as primary or secondary, depending on the etiology. Primary or essential hypertension still has its pathophysiology not fully elucidated, and there is no consensus in the literature on most underlying mechanisms. In this review, genetic and environmental factors, including sodium and potassium intake, socioeconomic status, ethnicity, family structure, obesity, sedentary lifestyle, prematurity and low birth weight, prenatal and postnatal exposures are highlighted.

OBJECTIVE

The present study aimed to perform an update on primary hypertension in childhood, providing clinicians and researchers an overview of the current state of the literature regarding the influence of genetic and environmental factors.

METHODS

This integrative review searched for articles on genetic and environmental factors related to primary hypertension in pediatric patients. The databases evaluated were PubMed and Scopus.

RESULTS

The studies have provided insights regarding many genetic and environmental factors, in addition to their association with the pathophysiology of primary hypertension in childhood. Findings corroborated the idea that primary hypertension is a multifactorial disease. Further studies in the pediatric population are needed to elucidate the underlying mechanisms.

CONCLUSION

The study of primary hypertension in pediatrics has utmost importance for the adoption of preventive measures and the development of more efficient treatments, therefore reducing childhood morbidity and the incidence of cardiovascular diseases and other health consequences later in life.

The relationship between maternal anxiety and cortisol during pregnancy and birth weight of chinese neonates

BACKGROUND

To determine the relationship between maternal anxiety and cortisol values and birth weight at various stages of pregnancy.

METHODS

Two hundred sixteen pregnant Chinese women were assessed for anxiety and depression and had measurement of morning fasting serum cortisol. Women were assessed either in the first (71), second (72) or third (73) trimester. Birth weights of all children were recorded.

RESULTS

There were significant negative correlations between anxiety level and birth weight of - 0.507 (p < 0.01) and - 0.275 (p < 0.05) in trimesters 1and 2. In trimester 3 the negative relation between anxiety and birth weight of -.209 failed to reach significance (p = 0.070). There was no relation between depression and birth weight in any trimester (p > 0.5 for all). Maternal cortisol was significantly inversely related to birth weight in trimester 1 (r = - 0.322) and with borderline significance in trimester 2 (r = - 0.229). Anxiety score and maternal cortisol were significantly correlated in each trimester (r = 0.551, 0.650, 0.537). When both anxiety score and maternal cortisol were simultaneously included in multiple regression analyses only anxiety score remained significant.

CONCLUSION

Whilst both maternal anxiety score and maternal cortisol are inversely related to birth weight the associations with anxiety score were more robust perhaps indicating the importance of mechanisms other than, or in addition to, maternal cortisol in mediating the effects of anxiety. The findings indicate the importance of measures to reduce maternal anxiety, particularly of a severe degree, at all stages of pregnancy.

TRIAL REGISTRATION

The study was approved by the Ethics Committee of the 1st Affiliated Hospital of Xi'an Jiaotong University.

Birth Weight, Postnatal Weight Gain, and Childhood Adiposity in Relation to Lipid Profile and Blood Pressure During Early Adolescence

Background

Different pathways likely underlie the association between early weight gain and cardiovascular disease risk. We examined whether birth weight for length relationship and weight gain up to 2 years of age are associated with lipid profiles and blood pressure (BP) in early adolescence and determined whether childhood adiposity mediates these associations.

Methods and Results

Data from QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), a cohort of white children with parental history of obesity, were analyzed (n=395). Sex‐specific weight for length z scores from birth to 2 years were computed. Rate of postnatal weight gain was estimated using individual slopes of weight for length z‐score measurements. Percentage of body fat was measured at 8 to 10 years. Fasting lipids and BP were measured at 10 to 12 years. Using path analysis, we found indirect effects of postnatal weight gain, through childhood adiposity, on all outcomes: Rate of postnatal weight for length gain was positively associated with childhood adiposity, which in turn was associated with unfavorable lipid and BP levels in early adolescence. In contrast, small beneficial direct effects on diastolic BP z scores, independent of weight at other time points, were found for birth weight for length (β=−0.05, 95% CI, −0.09 to −0.002) and for postnatal weight gain (β=−0.02, 95% CI, −0.03 to −0.002).

Conclusions

Among children with at least 1 obese parent, faster postnatal weight gain leads to cardiovascular risk factors in early adolescence through its effect on childhood adiposity. Although heavier newborns may have lower BP in early adolescence, this protective direct effect could be offset by a deleterious indirect effect linking birth weight to later adiposity.

Is high waist circumference and body weight associated with high blood pressure in Iranian primary school children?

INTRODUCTION AND OBJECTIVES

The prevalence of overweight, abdominal obesity and hypertension among children has increased worldwide including Iran over several decades. We carried out a study to provide current estimates of the prevalence and trends of hypertension, overweight and obesity along with the relationship between weight status and hypertension in Iranian school-children.

METHOD

This study was carried out among 1184 fifth-grade students, whose ages ranged from 11 to 14 years. Body weight, body mass index (BMI), height and waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP) were measured.

RESULTS

22.04 and 5.32 % of students were overweight and obese, respectively. The prevalence of overweight and obesity was significantly higher among girls than boys (all p = 0.02), whereas the prevalence of hypertension was significantly higher in boys than girls (p = 0.001). Although 27 % of boys and 24.32 % of girls had abdominal obesity, no significant associations were reported between abdominal obesity and sex (p = 0.12). The prevalence of hypertension in children with normal weight, overweight and obesity, was 3, 9.7 and 17.8 %, respectively (p < 0.01). We have obtained that the mean values of weight and WC were significantly higher in boys than girls. Based on linear regression, every 1 cm increase in abdominal circumference leads to an estimated DBP and SBP increase of 0.173 and 0.164 mmHg, respectively (p < 0.05).

CONCLUSIONS

This study showed a high prevalence of hypertension and obesity in a school-based population in Tehran, Iran, in which the prevalence of hypertension was significantly and positively correlated with weight and WC.

In Utero Origins of Hypertension: Mechanisms and Targets for Therapy

The developmental origins of health and disease theory is based on evidence that a suboptimal environment during fetal and neonatal development can significantly impact the evolution of adult-onset disease. Abundant evidence exists that a compromised prenatal (and early postnatal) environment leads to an increased risk of hypertension later in life. Hypertension is a silent, chronic, and progressive disease defined by elevated blood pressure (>140/90 mmHg) and is strongly correlated with cardiovascular morbidity/mortality. The pathophysiological mechanisms, however, are complex and poorly understood, and hypertension continues to be one of the most resilient health problems in modern society. Research into the programming of hypertension has proposed pharmacological treatment strategies to reverse and/or prevent disease. In addition, modifications to the lifestyle of pregnant women might impart far-reaching benefits to the health of their children. As more information is discovered, more successful management of hypertension can be expected to follow; however, while pregnancy complications such as fetal growth restriction, preeclampsia, preterm birth, etc., continue to occur, their offspring will be at increased risk for hypertension. This article reviews the current knowledge surrounding the developmental origins of hypertension, with a focus on mechanistic pathways and targets for therapeutic and pharmacologic interventions.

Effects of Maternal Cortisol during Pregnancy on Children's Blood Pressure Responses

BACKGROUND

It is well established that birth weight has an effect on subsequent blood pressure. Predominantly experimental studies have also reported effects of altered corticosteroid levels on subsequent cardiovascular responses. In the current study, we have examined the effects of both birth weight and maternal cortisol levels in a cohort of mothers and their pre-adolescent children.

PROCEDURE

A total of 216 women and their 7- to 9-year-old children comprised the cohort. The women had been assessed for plasma cortisol during the first (n = 71), second (n = 72) and third (n = 73) trimester. Maternal cortisol had been measured on a fasting sample taken between 9 and 11 a.m. The children's blood pressure and heart rate were recorded in the resting state, in response to a 10-min video game stress challenge and during recovery. Resting values, incremental responses to stress and recovery were evaluated.

OBSERVATION

Maternal cortisol levels increased with duration of pregnancy. There were inverse correlations between birth weight and all haemodynamic measures. The positive associations between maternal cortisol and children's haemodynamic measures were most evident in the first and second trimesters. Birth weight was inversely related to maternal cortisol. In multiple regression analyses, the effects of maternal cortisol were more consistent than those of birth weight.

CONCLUSION

Both birth weight and maternal cortisol are predictive of children's resting and stress-modulated haemodynamic measures. The effects of birth weight may partly mediate the effects of maternal cortisol.

Effects of maternal anxiety and depression during pregnancy in Chinese women on children's heart rate and blood pressure response to stress

Psychological disturbances, including anxiety and depression, are common during human pregnancy. Our objective was to determine whether these maternal disturbances influence cardiovascular responses of the offspring. The psychological status of 231 pregnant women was determined. Offspring (216) of these women were subsequently exposed to a video challenge stress when aged 7-9 years. Heart rate (HR) and blood pressure (BP) of the children were determined at rest, in response to video stress and during subsequent recovery. Children's resting and stress-induced increases in HR (bpm), systolic (SBP, mm Hg) and diastolic (DBP, mm Hg) BP were all greater in children whose mothers reported anxiety during pregnancy. Values (mean±s.d.) for resting HR, SBP and DBP were 75.15±5.87, 95.37±2.72 and 66.39±4.74 for children whose mothers reported no anxiety and an average of 81.62±6.71, 97.26±2.90 and 68.86±2.82 for children whose mothers reported anxiety at any level. Respective values for stress-induced increments in HR, SBP and DBP were 14.83.±2.14, 16.41±1.97 and 12.72±2.69 for children whose mothers reported no anxiety and 17.95±3.46, 18.74±2.46 and 14.86±2.02 for children whose mothers reported any level of anxiety. Effects of maternal depression were less consistent. The effects of maternal anxiety remained in multivariate analyses, which also included children's birth weight. The results indicate a long-term influence of maternal psychological status during pregnancy on the cardiovascular responses to stress among offspring. These effects may contribute to prenatal influences on subsequent health of the offspring.

How the kidney is impacted by the perinatal maternal environment to develop hypertension

Environmental conditions during perinatal development such as maternal undernutrition, maternal glucocorticoids, placental insufficiency, and maternal sodium overload can program changes in renal Na(+) excretion leading to hypertension. Experimental studies indicate that fetal exposure to an adverse maternal environment may reduce glomerular filtration rate by decreasing the surface area of the glomerular capillaries. Moreover, fetal responses to environmental insults during early life that contribute to the development of hypertension may include increased expression of tubular apical or basolateral membrane Na(+) transporters and increased production of renal superoxide leading to enhanced Na(+) reabsorption. This review will address the role of these potential renal mechanisms in the fetal programming of hypertension in experimental models induced by maternal undernutrition, fetal exposure to glucocorticoids, placental insufficiency, and maternal sodium overload in the rat.

Does low birth weight predict hypertension and obesity in schoolchildren?

BACKGROUND

Birth weight appears to play a role in determining high blood pressure (BP) and obesity during childhood. The purpose of this study is to investigate the association between birth weight and later obesity and hypertension among 10- to 13-year-old schoolchildren.

METHODS

A total of 1,184 primary school students were selected from 20 randomized schools between 2011 and 2012 in Iran. Height, weight, waist circumference and BP were measured using standard instruments. Data were analyzed using stepwise regression and logistic regression models.

RESULTS

13.5% of children had a history of low birth weight. First-degree family history of obesity, excessive gestational weight gain and birth weight were significantly correlated with overweight/obesity and abdominal obesity (p = 0.001), whereas only birth weight was associated with high BP (p = 0.001). An inverse correlation was found between waist circumference and systolic/diastolic BP. The duration of breastfeeding in children with low birth weight was inversely correlated with obesity/overweight, abdominal obesity and hypertension.

CONCLUSION

The results suggests that birth weight is inversely associated with BP and more so with obesity and abdominal obesity. The duration of having been breastfed could have an influence on later hypertension, obesity and abdominal obesity. Further results are needed to test these correlations as well as diagnosing early life factors to prevent young adult overweight/obesity or hypertension.

Relationship between Breast Feeding and Obesity in Children with Low Birth Weight

Background

Breast feeding appears to play a role in determining obesity and abdominal obesity during childhood, specifically in children with a history of low birth weight.

Objective

The purpose of this study is to investigate the relation of breast-feeding with either of abdominal obesity and obesity among Iranian school children.

Materials and Methods

A total of 1184 students (625 girls and 559 boys), aged 10 to 13 years old, were selected from 112 governmental elementary schools in Iran. Height, weight, waist circumference and blood pressure were measured using standard instruments and a pretested standardized questionnaire was performed for compiling information about family economics and educational level, first–degree family history of obesity, history of breast feeding, food pattern and birth weight, as well.

Results

13.68% (n = 160) of students had a history of low birth weight, and 26.41% of them had abdominal obesity. Of all participants, 22.04% were overweight and 5.32% were obese which was more prevalent in girls than in boys (P = 0.03). First-degree family history of obesity (P = 0.001), excessive gestational weight gain (P = 0.001) and birth weight (P = 0.01) were significantly correlated with the prevalence of obesity and abdominal obesity during childhood. Moreover the prevalence of abdominal obesity in children with low birth weight was significantly correlated with breast feeding (P = 0.04); But this relation was not significantly about obesity in our participants (P = 0.9). Furthermore duration of breast feeding was significantly and inversely correlated with obesity and abdominal obesity in schoolchildren with low birth weight (P = 0.01).

Conclusions

The results suggest that Breast feeding and its long-term consequences were important factors for preventing metabolic syndrome criteria in childhood and later years of life span. With regard to the increasing prevalence of obesity in children, more research is urgently needed to clarify whether breast feeding have negative consequences for the risk of chronic disease in children, especially in children with low birth weight.

Birth weight and childhood blood pressure

A large body of literature suggests an inverse relationship between birth weight and blood pressure in children, adolescents and adults. The most persistent findings have been observed in children with a history of low birth weight or intrauterine growth restriction, while a large number of studies carried out in populations with normally distributed birth weight have shown conflicting results. A recently reported strong direct association between high birth weight and blood pressure, and the significant positive effect of postnatal growth on blood pressure suggests that the fetal origins of adult disease hypothesis should be expanded to include the role of excessive fetal and postnatal growth. In this paper, we review recent studies on the relationship between birth weight and blood pressure in childhood, with a focus on confounding variables that may explain the conflicting results of published work in this field.

High sensitivity C-reactive protein concentrations, birthweight and cardiovascular risk markers in Brazilian children

BACKGROUND/OBJECTIVES

High sensitivity C-reactive protein (hs-CRP) and low birthweight have emerged as predictors of cardiovascular diseases (CVDs). In studies involving adults, higher concentrations of hs-CRP have been associated with low birthweight. This study assessed the relationship between hs-CRP and birthweight, and other risk markers for CVDs in childhood.

SUBJECTS/METHODS

A total of 459 Brazilian children aged 5-8 years were included in the study. hs-CRP was measured by particle-enhanced immunonephelometry. The nutritional status of the children was assessed by BMI and waist circumference. Total cholesterol and fractions, triglycerides and glucose were measured by enzymatic methods. Insulin sensitivity was determined by the homeostasis model assessment (HOMA) method. Blood pressure was measured by the HDI/Pulse Wave CR-2000 equipment (Hypertension Diagnostics, Eagan, MN, USA). A multivariate linear regression analysis investigated the association between hs-CRP and birthweight, and risk markers for CVDs.

RESULTS

There were positive associations between hs-CRP and gender (P=0.001), waist circumference (P<0.001) and systolic blood pressure (SBP) (P=0.03), and negative associations between hs-CRP and age (P<0.001), and high-density lipoprotein cholesterol (HDL-c) (P=0.005) (R²=0.14). Abnormal values of hs-CRP, waist circumference, HDL-c and SBP, respectively, were observed in 27.7, 26.4, 14.4 and 34.7% of the children.

CONCLUSIONS

Opposite to studies involving adults, there was no association between hs-CRP and birthweight, implying that time may strengthen the relationship, considering that hs-CRP-concentration-associated metabolic changes increase from childhood to adulthood. The associations between hs-CRP and waist circumference, HDL-c and SBP in very young ages is a matter of concern, especially in females, in view of the large number of children with abnormal values of these measurements.

Nutritional status and lipid profile of young children in Brazil

OBJECTIVE

To evaluate the nutritional status and lipid profile of young children from an urban Brazilian region.

METHODS

Cross-sectional study involving a representative sample of 472 children aged 5-8 years from Jundiai city. The nutritional status was assessed by the body mass index for age. Total cholesterol and fractions (low-density lipoprotein cholesterol, high density lipoprotein cholesterol) and triglycerides concentrations were determined by automated enzymatic methods. The results were analyzed by the student t-test and Fisher exact test.

RESULTS

Overweight/obesity was observed in 22% of the children and thinness in 3.2%. Girls presented a higher prevalence of overweight/obesity (24.0%) and lower levels of high-density lipoprotein cholesterol (22.8%) compared with boys (19.7% and 10.6%), respectively (p < 0.001). The prevalence of children with elevated and borderline total cholesterol was 32.8% and 26.7%, respectively, although 82.8% had desirable levels of high-density lipoprotein cholesterol.

CONCLUSION

The prevalence of overweight/obesity and dyslipidaemia observed in these children is a matter of concern considering the age group evaluated.

Impact of nutrition since early life on cardiovascular prevention

The cardiovascular disease represents the leading cause of morbidity and mortality in Western countries and it is related to the atherosclerotic process. Cardiovascular disease risk factors, such as dyslipidemia, hypertension, insulin resistance, obesity, accelerate the atherosclerotic process which begins in childhood and progresses throughout the life span. The cardiovascular disease risk factor detection and management through prevention delays the atherosclerotic progression towards clinical cardiovascular disease. Dietary habits, from prenatal nutrition, breastfeeding, complementary feeding to childhood and adolescence nutrition play a basic role for this topic.

The metabolic and neuroendocrine environment of the fetus is fundamental in the body’s “metabolic programming”. Further several studies have demonstrated the beneficial effects of breastfeeding on cardiovascular risk factors reduction. Moreover the introduction of complementary foods represents another important step, with particular regard to protein intake. An adequate distribution between macronutrients (lipids, proteins and carbohydrates) is required for correct growth development from infancy throughout adolescence and for prevention of several cardiovascular disease risk determinants in adulthood.

The purpose of this review is to examine the impact of nutrition since early life on disease.

La malattia cardiovascolare rappresenta la principale causa di morbilità e mortalità dei paesi occidentali ed è correlata a degenerazione vascolare aterosclerotica. I fattori di rischio cardiovascolari quali dislipidemia, ipertensione, insulino resistenza e obesità accelerano tale processo il cui esordio è noto sin dell’età pediatrica ed evolve nel corso della vita. L’individuazione e la cura dei fattori di rischio cardiovascolari mediante la prevenzione dei fattori causali ritardano la progressione dell’aterosclerosi e l’insorgenza dei sintomi cardiovascolari. La nutrizione svolge un ruolo preventivo fondamentale sin dall’epoca prenatale e nelle diverse età della crescita.

La condizione metabolica e neuro-endocrino cui è sottoposto il feto è rilevante per la “programmazione metabolica”. E’ dimostrata inoltre l’importanza delle modalità di allattamento e divezzamento con particolare interesse per l’assunzione di proteine nel controllo dei fattori di rischio cardiovascolari. La corretta distribuzione di macronutrienti (lipidi, proteine e carboidrati) dall’infanzia all’adolescenza favorisce una crescita corretta e risulta utile a prevenire l’insorgenza dei determinanti di rischio di malattia cardiovascolare in età adulta.

Nella presente review verrà esaminato l’impatto della nutrizione dalle più precoci fasi delle vita sul rischio cardiovascolare.