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In utero teratogen exposure and cardiometabolic risk in 5-year-old children: a prospective pediatric study
J J A De Smidt1, H J Odendaal2, D G Nel3
1Department of Medical Biosciences, University of the Western Cape, South Africa.
Insights
Maternal smoking and alcohol consumption during pregnancy are linked to increased intima-media thickness (IMT), a marker of cardiometabolic risk, in 5-year-old children. This study highlights the long-term cardiovascular impact of prenatal teratogen exposure.
Area of Science:
- Cardiovascular Health
- Pediatric Health
- Prenatal Development
Background:
- Intima-media thickness (IMT) of the aorta and carotid arteries serves as a key indicator of subclinical atherosclerosis and cardiometabolic risk in children.
- The prenatal environment, influenced by maternal factors like smoking and alcohol use, can program cardiometabolic risk factors in offspring.
- DNA methylation is a mechanism through which maternal lifestyle choices during pregnancy can affect fetal cardiovascular development.
Purpose of the Study:
- To investigate the association between maternal smoking and alcohol consumption during pregnancy and the intima-media thickness (IMT) of 5-year-old children in a low-income population.
- To identify early indicators of cardiometabolic risk in children exposed to dual teratogens in utero.
Main Methods:
- A cohort of 500 mother-child pairs was followed from pregnancy through the child's fifth year, with data collected at antenatal visits, birth, and age 5.
- Anthropometric measurements, blood pressure, heart rate, and ultrasound-based IMT of the aorta and carotid arteries were assessed at age 5.
- Statistical analyses explored the effect of dual *in utero* exposure (maternal smoking and alcohol consumption) on IMT, considering factors like sex and birth weight.
Main Results:
- Children exposed to both maternal alcohol and nicotine *in utero* exhibited significantly higher carotid intima-media thickness (cIMT) at age 5 (p = .008).
- Dual *in utero* exposure, male sex, and low birth weight were independently associated with increased cIMT and aorta IMT.
- Maternal adiposity (BMI and MUAC) showed a positive correlation with right cIMT, while child's BMI at age 5 correlated with blood pressure.
Conclusions:
- Prenatal exposure to both maternal smoking and alcohol consumption is associated with the presence of cardiometabolic risk factors by age 5.
- Higher IMT at age 5 is also linked to maternal adiposity, male sex, and low birth weight, underscoring multifactorial influences on early cardiovascular health.
Background:
Aorta and carotid intima-media thickness (IMT) is a measure of subclinical atherosclerosis and useful to assess cardiometabolic risk in the young. The in utero milieu may involve cardiometabolic programing and the development of cardiometabolic risk factors in children. Maternal smoking, alcohol consumption, and micronutrient deficiencies during pregnancy influence the development of the cardiovascular system through a process of DNA methylation.
Aim:
To explore an association between maternal smoking and alcohol consumption during pregnancy and intima media thickness in 5-year-old children for a low-income setting.
Methods:
Data were collected from 500 mother-child pairs at antenatal clinic visit, at birth, and at age 5 years. Anthropometric measurements were collected at birth and again at age 5 years. As well as clinical and ultrasound measurements at age 5 years. Clinical measurements, at age 5 years, included blood pressure, mean arterial pressure, and heart rate. Ultrasound measurements of the aorta and carotid arteries IMT were performed at age 5 years. Main outcome of interest was effect of dual teratogen exposure on the ultrasound measures IMT as indication of cardiometabolic risk.
Results:
cIMT was significantly higher in children exposed to both alcohol and nicotine during pregnancy compared to those not exposed (p = .008). In separate linear models, dual in utero exposure (beta = 0.12; p = .01) and male sex (beta = 0.14; p = .01) were associated with higher right cIMT values (F(6,445) = 5.20; R2 = 0.07, p < .01); male sex (beta = 0.13; p = .01) and low birth weight (beta = 0.07; p = .01) with higher left cIMT value (F(4,491) = 4.49; R2 = 0.04; p = .01); and males sex (beta = 0.11; p = .02) with higher aorta IMT (F(6,459) = 5.63; R2 = 0.07; p < .01). Significant positive correlations between maternal measures of adiposity, maternal MUAC (r = 0.10; p = .03), and maternal BMI (r = 0.12; p < .01) and right cIMT measurements adjusted for the BMI of the child at age 5 years as covariate. Blood pressure measurements at age 5 years were not significantly associated with IMT but, instead, correlated significantly and positively with the BMI of the child at age 5 years (p < .01).
Conclusion:
Children exposed to both maternal smoking and alcohol consumption during pregnancy presented with cardiometabolic risk factors 5 years after birth. In addition, maternal adiposity, male sex, and low birth weight were associated with higher IMT at age 5 years.
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