Maternal Health Risks Linked to Elevated Blood Pressure in Children

A study from the Keck School of Medicine of USC highlights the long-term impact of maternal health risks during pregnancy, revealing a connection between conditions such as obesity, gestational diabetes and hypertensive disorders of pregnancy with higher blood pressure in offspring.

The research, published in JAMA Network Open, indicates that children exposed to at least one of these risks had higher systolic and diastolic blood pressure, and their blood pressure increased more quickly between ages 2 and 18 compared to children whose mothers did not have these conditions.

Maternal health shapes offspring's cardiovascular health

This study examined nearly 30 years of data from mother-child pairs across the United States, providing valuable insights into the role of maternal cardiometabolic health in shaping children’s blood pressure. Maternal obesity, gestational diabetes and hypertensive disorders of pregnancy were the primary risk factors considered.

The researchers used data from the Environmental influences on Child Health Outcomes (ECHO) Program, which provided demographic and health information on the study participants. The program consists of 12,480 mother-child pairs, with nearly half of the mothers (44.4%) having at least one cardiometabolic risk factor. Of these mothers, 24.6% had obesity, 13.6% had hypertensive disorders during pregnancy and 6.5% had gestational diabetes.

Blood pressure readings for the children were used to calculate systolic blood pressure (SBP) and diastolic blood pressure (DBP) percentiles, which estimate how a child’s blood pressure compares to peers of the same age, sex and height. These readings were analyzed alongside maternal risk factors to identify patterns and associations.

Previous research on the relationship between maternal health and offspring blood pressure has often examined these conditions in isolation, but this study looked at their combined effects. It found that children whose mothers had at least one of these conditions had an average SBP that ranked 4.88 percentile points higher than children born to mothers without these risks. DBP was also elevated by an average of 1.90 percentile points.

The impact of cardiometabolic risk factors

The study highlighted a faster increase in blood pressure over time in children born to mothers with cardiometabolic risks. Specifically, blood pressure increased more quickly between ages 2 and 18 in these children, with SBP rising by 0.5 percentile points per year and DBP by 0.7 percentile points per year. The findings point to the potential benefits of early intervention, possibly starting during pregnancy, to manage blood pressure risks.

The research also showed that the effects were more pronounced in female offspring and in Black children, suggesting that certain subgroups may be more vulnerable to the long-term effects of maternal health risks.

Prevention and future directions

The study's findings suggest that improving cardiovascular health in women of childbearing age could not only benefit maternal health but also support the health of future generations. 

“We still have so much to learn about how we can prevent the development of cardiovascular disease,” said Shohreh Farzan, PhD, associate professor of population and public health sciences at the Keck School of Medicine and the study’s senior author. “Finding factors that we can address during pregnancy and childhood—and implementing early interventions—may be key to changing the trajectories of health for future generations.”

The authors believe that earlier blood pressure screenings in children, even for those who seem healthy otherwise, could help to identify potential issues early and prevent more severe outcomes later in life.

“Currently, most clinical guidelines do not suggest blood pressure screenings for children who seem healthy overall,” said first author Zhongzheng (Jason) Niu, PhD, a Presidential Sustainability Solutions Fellow at the University of Southern California and an assistant professor of epidemiology and environmental health at the University at Buffalo. “But our evidence is clear, showing that even a small blood pressure difference in early life can magnify over a longer period.”

The researchers are now also investigating how environmental factors, such as air pollution and stress, contribute to cardiometabolic health in children and whether these factors could also play a role in shaping blood pressure outcomes.

Reference: Niu Z, Ako AA, Geiger SD, et al. Maternal cardiometabolic risk factors in pregnancy and offspring blood pressure at age 2 to 18 years. JAMA Netw Open. 2025;8(5):e259205. doi: 10.1001/jamanetworkopen.2025.9205

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