Maternal educational level and blood pressure, aortic stiffness, cardiovascular structure and functioning in childhood: the generation R study.
BACKGROUND
In adults, low level of education was shown to be associated with higher blood pressure levels and alterations in cardiac structures and function. It is currently unknown whether socioeconomic inequalities in arterial and cardiac alterations originate in childhood. Therefore, we investigated the association of maternal education with blood pressure levels, arterial stiffness, and cardiac structures and function at the age of 6 years and potential underlying factors.


METHODS
The study included 5,843 children participating in a prospective cohort study in the Netherlands. Maternal education was assessed at enrollment. Blood pressure, carotid-femoral pulse wave velocity, left atrial diameter, aortic root diameter, left ventricular mass, and fractional shortening were measured at the age of 6 years.


RESULTS
Children with low educated (category 1) mothers had higher systolic (2.80mm Hg; 95% confidence interval (CI) = 1.62-2.94) and diastolic (1.80mm Hg; 95% CI = 1.25-2.35) blood pressure levels compared with children with high educated (category 4) mothers. The main explanatory factors were the child's body mass index (BMI), maternal BMI, and physical activity. Maternal education was negatively associated with fractional shortening (P trend = 0.008), to which blood pressure and child's BMI contributed the most. No socioeconomic gradient was observed in other arterial and cardiac measurements.


CONCLUSIONS
Socioeconomic inequalities in blood pressure are already present in childhood. Higher fractional shortening among children from low socioeconomic families might be a first cardiac adaptation to higher blood pressure and higher BMI. Interventions should be aimed at lowering child BMI and increasing physical activity among children from low socioeconomic families.
The Generation R Study Group, Erasmus Medical Centre, Rotterdam, the Netherlands.
Selma H
SH
Bouthoorn
Frank J
FJ
Van Lenthe
Layla L
LL
De Jonge
Albert
A
Hofman
Lennie
L
Van Osch-Gevers
Vincent W V
VW
Jaddoe
Hein
H
Raat
D000328:Adult; D000367:Age Factors; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers; D009043:Motor Activity; D009200:Myocardial Contraction; D009426:Netherlands; D011446:Prospective Studies; D012307:Risk Factors; D059289:Vascular Stiffness; D016277:Ventricular Function, Left
arterial stiffness; blood pressure; cardiac function; cardiac structures; childhood; hypertension; maternal educational level.