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      Association of preeclampsia with anthropometric measures and blood pressure in Indian children

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          Abstract

          Background and objective

          Birth weight and post-natal growth are important predictors of adult health. Preeclampsia (PE) is associated with low birth weight and may have long term effects on the health of the children. The current study aims to compare anthropometry and blood pressure between children of mothers with and without PE in an Indian cohort.

          Methods

          We studied children born to women with (PE; n = 211) and without preeclampsia (non-PE; n = 470) at Bharati Hospital, Pune, India. Anthropometry and blood pressure were measured in children at 3–7 years of age. Weight and height Z-scores were calculated using the WHO 2006 growth reference. Independent t-tests were used to compare means between the two groups, and associations between preeclampsia and child outcomes were analyzed using multiple linear regression, adjusting for potential confounders.

          Results

          Weight and height Z-scores (p = 0.04 and 0.008), and subscapular skinfold thickness (p = 0.03) were higher among children of PE compared with children of non-PE mothers. Systolic blood pressure was also higher in children of PE mothers (1.70 mmHg [95% CI 0.05, 2.90] p = 0.006). BMI and diastolic blood pressure did not differ between groups. In regression models adjusted for newborn weight and gestational age, current age and sex, and maternal height, BMI and socio-economic status, children of PE mothers had higher weight Z-score (0.27 SD [95%CI 0.06, 0.48] p = 0.01), height Z-score (0.28 SD [95%CI 0.09, 0.47] p = 0.005), and subscapular skinfold thickness (0.38 mm [95%CI 0.00, 0.76] p = 0.049). A trend for higher systolic blood pressure (1.59 mmHg [95%CI -0.02, 3.20] p = 0.053) in the children was also observed in the adjusted model. The difference in systolic blood pressure was attenuated after adjusting further for the child’s weight and height (1.09 mmHg [95%CI -0.48, 2.67] p = 0.17). There was no evidence of differences in effects between boys and girls.

          Conclusion

          Children of PE mothers were taller and heavier, and had higher systolic blood pressure, partly explained by their increased body size, than children of non-PE mothers. In utero exposure to preeclampsia may increase the risk of future cardiovascular disease.

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          Most cited references25

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          Developmental origins of noncommunicable disease: population and public health implications.

          Noncommunicable diseases (NCDs), including cardiovascular disease, diabetes, chronic lung disease, allergy, some forms of cancer, cognitive decline, osteoporosis, sarcopenia, and affective disorders, are the world's biggest killers. Eighty percent of these deaths occur in low- and middle-income countries, especially as these countries undergo socioeconomic improvement after reductions in infectious disease. The World Health Organization predicts a global increase of 17% in NCDs over the next decade. NCDs are preventable, but new initiatives are needed to institute such prevention, especially in early life. In this article, we emphasize that all children are affected by their early developmental conditions, not just children exposed to a very deficient environment, and that this has long-term consequences for their predisposition to NCDs. We highlight the biomedical implications of this developmental origins of health and disease (DOHaD) concept of NCDs and discuss the implications for health policy.
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            Vascular biology of preeclampsia.

            Preeclampsia, a pregnancy-specific syndrome characterized by hypertension, proteinuria and edema, resolves on delivery of the placenta. Normal pregnancy is itself characterized by systemic inflammation, oxidative stress and alterations in levels of angiogenic factors and vascular reactivity. This is exacerbated in preeclampsia with an associated breakdown of compensatory mechanisms, eventually leading to placental and vascular dysfunction. The underlying pathology of preeclampsia is thought to be a relatively hypoxic or ischemic placenta. Both the placenta and maternal vasculatures are major sources of reactive oxygen and nitrogen species which can interact to produce peroxynitrite a powerful prooxidant that covalently modifies proteins by nitration of tyrosine residues, to possibly alter vascular function in preeclampsia. The linkage between placental hypoxia and maternal vascular dysfunction has been proposed to be via placental syncytiotrophoblast basement membranes shed by the placenta or via angiogenic factors which include soluble flt1 and endoglin secreted by the placenta that bind vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) in the maternal circulation. There is also abundant evidence of altered reactivity of the maternal and placental vasculature and of the altered production of autocoids in preeclampsia. The occurrence of preeclampsia is increased in women with preexisting vascular disease and confers a long-term risk for development of cardiovascular disease. The vascular stress test of pregnancy thus identifies those women with a previously unrecognized at risk vascular system and promotes the development of preeclampsia. Preexisting maternal vascular dysfunction intensified by placental factors is possibly responsible for the individual pathologies of preeclampsia.
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              Hypertension in Pregnancy and Offspring Cardiovascular Risk in Young Adulthood: Prospective and Sibling Studies in the HUNT Study (Nord-Trøndelag Health Study) in Norway.

              Women with hypertensive disorders in pregnancy are at increased lifetime risk for cardiovascular disease. We examined the offspring's cardiovascular risk profile in young adulthood and their siblings' cardiovascular risk profile. From the HUNT study (Nord-Trøndelag Health Study) in Norway, 15 778 participants (mean age: 29 years), including 210 sibling groups, were linked to information from the Medical Birth Registry of Norway. Blood pressure, anthropometry, serum lipids, and C-reactive protein were assessed. Seven hundred and six participants were born after exposure to maternal hypertension in pregnancy: 336 mothers had gestational hypertension, 343 had term preeclampsia, and 27 had preterm preeclampsia. Offspring whose mothers had hypertension in pregnancy had 2.7 (95% confidence interval, 1.8-3.5) mm Hg higher systolic blood pressure, 1.5 (0.9-2.1) mm Hg higher diastolic blood pressure, 0.66 (0.31-1.01) kg/m(2) higher body mass index, and 1.49 (0.65-2.33) cm wider waist circumference, compared with offspring of normotensive pregnancies. Similar differences were observed for gestational hypertension and term preeclampsia. Term preeclampsia was also associated with higher concentrations of non-high-density lipoprotein cholesterol (0.14 mmol/L, 0.03-0.25) and triglycerides (0.13 mmol/L, 0.06-0.21). Siblings born after a normotensive pregnancy had nearly identical risk factor levels as siblings born after maternal hypertension. Offspring born after maternal hypertension in pregnancy have a more adverse cardiovascular risk profile in young adulthood than offspring of normotensive pregnancies. Their siblings, born after a normotensive pregnancy, have a similar risk profile, suggesting that shared genes or lifestyle may account for the association, rather than an intrauterine effect. All children of mothers who have experienced hypertension in pregnancy may be at increased lifetime risk of cardiovascular disease.
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                Author and article information

                Contributors
                Role: Formal analysis
                Role: InvestigationRole: Methodology
                Role: InvestigationRole: Methodology
                Role: Writing – original draftRole: Writing – review & editing
                Role: Methodology
                Role: Methodology
                Role: Methodology
                Role: Methodology
                Role: Formal analysis
                Role: Formal analysis
                Role: Formal analysis
                Role: Formal analysisRole: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                5 May 2020
                2020
                : 15
                : 5
                : e0231989
                Affiliations
                [1 ] Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
                [2 ] Dept. of Pediatrics, Bharati Hospital and Research Centre, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
                [3 ] MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
                [4 ] Diabetes Unit of KEM Hospital and Research Centre, Rasta Peth, Pune, India
                University of Cambridge, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-0551-7183
                Article
                PONE-D-20-01076
                10.1371/journal.pone.0231989
                7199948
                32369488
                28585498-acee-4bb9-b286-97c7200dfe6e
                © 2020 Randhir et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 January 2020
                : 3 April 2020
                Page count
                Figures: 1, Tables: 4, Pages: 13
                Funding
                Funded by: Department of Biotechnology
                Award ID: BT/PR10596/PFN/20/995/201; SJ
                Award Recipient :
                Funded by: Wellcome Trust supplementary grant
                Award ID: 098575/Z/12/Z; CF
                Award Recipient :
                The study is supported by the Department of Biotechnology (Govt. of India), New Delhi India (BT/PR10596/PFN/20/995/201; SJ) and by Wellcome Trust supplementary grant (098575/Z/12/Z; CF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Pregnancy Complications
                Preeclampsia
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Pregnancy Complications
                Preeclampsia
                People and Places
                Population Groupings
                Families
                Mothers
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Hypertensive Disorders in Pregnancy
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Hypertensive Disorders in Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Hypertensive Disorders in Pregnancy
                Biology and Life Sciences
                Anatomy
                Anthropometry
                Medicine and Health Sciences
                Anatomy
                Anthropometry
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Biology and Life Sciences
                Developmental Biology
                Neonates
                Custom metadata
                The study data are not freely available due to legal restrictions, and Government of India’s Health Ministry Screening Committee (HMSC) assessment is required to obtain the data. The anonymized data from the present study will be available on request subject to HMSC approval. To request data access, bona fide researchers will need to make a formal application to the Interactive Research School for Health Affairs ( director.irsha16@ 123456gmail.com ), Bharati Vidypeeth University Research Advisory Committee ( director.irsha16@ 123456gmail.com ), and Bharati Vidyapeeth Institutional Ethics committee ( meghanapadwal76@ 123456gmail.com ) through the cohort PI (Dr. Sadhana Joshi). The cohort investigators will provide the data to any interested party/parties upon ethical approval. For further information contact the corresponding author: Dr. Sadhana Joshi ( srjoshi62@ 123456gmail.com )

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