Children born to mothers with obesity, gestational diabetes mellitus or a hypertensive disorder of pregnancy have higher systolic and diastolic blood pressure than children born to mothers without these risk factors, according to a new USC study. Among children whose mothers had at least one risk factor, blood pressure also rose more quickly between ages 2 and 18 compared to their peers. The findings, which suggest that blood pressure interventions could start as early as pregnancy, were just published in JAMA Network Open .
Across the country, heart health is declining, with hypertension affecting more people—and showing up earlier in life. Growing evidence indicates that blood pressure levels may be shaped by early development, even before birth. But most research on maternal and child heart health has looked at risk factors individually, rather than exploring their combined role.
A new study from the Keck School of Medicine of USC has examined links and interactions between a mother's cardiometabolic health during pregnancy and her child's blood pressure up to age 18. The study included nearly 30 years of data from 12, 480 mother-child pairs across the United States.
"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."
Funded by the National Institutes of Health, Farzan and her colleagues found that children born to mothers with at least one cardiometabolic risk factor had a systolic blood pressure (SBP) that averaged 4.88 percentile points higher than children whose mothers had no risk factors. Diastolic blood pressure (DBP) averaged 1.90 percentile points higher. Children born to mothers with one or more risk factors also had a faster increase in blood pressure between ages 2 and 18.
The findings can help shape prevention efforts on both ends of the equation, including lifestyle changes for women of childbearing age and earlier blood pressure screenings for at-risk children, said Zhongzheng (Jason) Niu, PhD, the study's first author, a Presidential Sustainability Solutions Fellow at USC and assistant professor of epidemiology and environmental health at the University at Buffalo.
Blood pressure percentiles
Researchers used data collected between January 1994 and March 2023 through the Environmental influences on Child Health Outcomes (ECHO) Program. The data include demographic and health information on 12,480 mother-child pairs from across the country, about half of whom identified as non-white.
Nearly half of the mothers in the study (5,537, or 44.4%) had at least one cardiometabolic risk factor. Obesity was the most common, affecting 3,072 mothers (24.6%), followed by hypertensive disorders of pregnancy, which include gestational hypertension, preeclampsia and other conditions (1,693 mothers, or 13.6%) and gestational diabetes mellitus (805 mothers, or 6.5%).
For children, researchers used blood pressure readings to calculate SBP and DBP percentiles, which estimate how a child's blood pressure compares to that of peers who are the same age, sex and height.
The researchers then conducted a statistical analysis to examine how maternal risk factors related to blood pressure in their offspring down the line. They accounted for other variables that could influence the results, including maternal age, race/ethnicity, education, income, number of previous pregnancies and smoking during pregnancy.
Elevated blood pressure
At their first blood pressure reading, children born to mothers with any cardiometabolic risk factor ranked in a higher SBP percentile (4.88 points higher, on average) and DBP percentile (1.09 points higher, on average) than their peers born to mothers with no risk factors.
Children born to mothers with two risk factors faced even higher blood pressure. For example, when mothers had both obesity and a hypertensive disorder of pregnancy, their children had SBP that averaged 7.31 points higher and DBP that averaged 4.04 points higher than children whose mothers had no risk factors.
The effects were more pronounced in female compared to male offspring and in Black children compared to other racial and ethnic groups.
Among the children in the study, 6,015 had at least two blood pressure readings, which allowed researchers to assess how maternal risks related to changes in a child's blood pressure over time. They found that SBP (0.5 points/year) and DBP (0.7 points/year) rose more quickly between ages 2 and 18 in children whose mother had at least one risk factor, compared to children whose mother had no risk factors.
Screening and prevention
The findings show that on top of directly benefiting women, better cardiovascular health during the childbearing years can also support health in the next generation, Niu said. A 2025 statement from the American Heart Association highlights strategies for boosting heart health in young adults, including improving social connectedness and reducing substance use.
Earlier blood pressure screenings for children—even those who are healthy by other measures—could also help identify candidates for intervention before problems arise.
"Currently, most clinical guidelines do not suggest blood pressure screenings for children who seem healthy overall," Niu said. "But our evidence is clear, showing that even a small blood pressure difference in early life can magnify over a longer period."
Farzan, Niu and their colleagues are also studying how various combinations of environmental and social factors, such as air pollution and stress, may influence cardiometabolic health in children.
About this research
In addition to Farzan and Niu, the study's other authors are Carrie V. Breton and Theresa M. Bastain from the Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California; Ako Adams Ako from Children's Hospital at Montefiore, New York, New York; Sarah Dee Geiger from the University of Illinois Urbana-Champaign; Caitlin G. Howe and Margaret R. Karagas from the Geisel School of Medicine, Dartmouth College; Wei Perng, Amy J. Elliott and Dana Dabelea from the Colorado School of Public Health, University of Colorado Anschutz Medical Campus; Rachana Singh from Tufts University School of Medicine; Andrea Cassidy-Bushrow from Henry Ford Health, Detroit, Michigan; Carlos A. Camargo from Massachusetts General Hospital and Harvard Medical School; Keia Sanderson from the Department of Medicine, University of North Carolina; Cindy T McEvoy from Papé Pediatric Research Institute, Oregon Health & Science University; Emily Oken and Lyndsey E Shorey-Kendrick from the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; Tina V. Hartert from Vanderbilt University Medical Center; Brian Carter from Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, Missouri; Annemarie Stroustrup from the Department of Pediatrics, Cohen Children's Medical Center at Northwell Health, New York, New York; Andrea Lampland from the Department of Neonatology, Children's Minnesota; Thomas G. O'Connor from the Department of Psychiatry, University of Rochester Medical Center; Semsa Gogcu from the Department of Pediatrics, Wake Forest University School of Medicine; Mark L. Hudak from the Department of Pediatrics, University of Florida College of Medicine; Qi Zhao from the College of Medicine, University of Tennessee Health Science Center; Yu Ni from the School of Public Health, University of Washington and the School of Public Health, San Diego State University; Jeffrey VanWormer from Marshfield Clinic Research Institute, Marshfield, Wisconsin; Assiamira Ferrara, Monique Hedderson and Yeyi Zhu from the Division of Research, Kaiser Permanente Northern California; Akram Alshawabkeh from the Department of Civil and Environmental Engineering, Northeastern University; Jose Cordero from the College of Public Health, University of Georgia; Daphne Koinis Mitchell from the Warren Alpert Medical School, Brown University; and Susan Carnell from the Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University.
This work was supported by the National Institutes of Health Environmental influences on Child Health Outcomes program [UH3OD023287].
