Association of Maternal Plasma Folate and Cardiometabolic Risk Factors in Pregnancy with Elevated Blood Pressure of Offspring in Childhood.
BACKGROUND
The prevalence of childhood elevated blood pressure (BP) has increased in the United States, particularly among African Americans. The influence of maternal plasma folate levels, alone or in combination with maternal cardiometabolic risk factors (hypertensive disorders, diabetes, and prepregnancy obesity), on child systolic BP (SBP) has not been examined in a prospective birth cohort. We hypothesize that adequate maternal folate levels can reduce the risk of elevated SBP in children born to mothers with cardiometabolic risk factors.


METHODS
This study included 1,290 mother-child dyads (875 African Americans (67.8%)) recruited at birth and followed prospectively up to age 9 years from 2003 to 2014 at the Boston Medical Center. Child SBP percentile was calculated according to US reference data and elevated SBP was defined as SBP ≥75th percentile.


RESULTS
Maternal folate levels, overall, were not associated with child SBP. However, we found a significant multiplicative interaction between maternal cardiometabolic risk factors and maternal folate levels (Pinteraction = 0.015) on childhood elevated SBP. Among children born to mothers with any cardiometabolic risk factors, those whose mothers had folate levels above (vs. below) the median had 40% lower odds of elevated childhood SBP (odds ratio = 0.60, 95% confidence interval: 0.40-0.90). The associations did not differ appreciably in analyses restricted to African Americans, and they were not explained by gestational age, size at birth, prenatal folate intake, or breastfeeding.


CONCLUSIONS
Findings from our urban minority birth cohort suggest that higher levels of maternal folate may help counteract the adverse associations of maternal cardiometabolic risk factors on child SBP.
Department of Cardiovascular Internal Medicine, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.|Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Hongjian
H
Wang
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
Noel T
NT
Mueller
Department of Cardiology, Peking University First Hospital, Beijing, China.
Jianping
J
Li
Department of Cardiology, Peking University People's Hospital, Beijing, China.
Ninglin
N
Sun
Department of Cardiology, Peking University First Hospital, Beijing, China.
Yong
Y
Huo
Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Laboratory for Food Quality and Safety, and Key Laboratory of Functional Dairy, College of Food Science & Nutritional Engineering, China Agricultural University, Beijing, China.
Fazheng
F
Ren
Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.|Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Xiaobin
X
Wang
D000328:Adult; D001741:Black or African American; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D016015:Logistic Models; D024821:Metabolic Syndrome / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D011379:Prognosis; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
D015415:Biomarkers; D005492:Folic Acid
blood pressure; child; hypertension; interaction; maternal cardiometabolic risk factors; maternal folate