Maternal Diet During Pregnancy and Carotid Intima–Media Thickness in Children

Abstract

Objective-Autopsy studies show that intimal lipid accumulations in arteries are often present at birth, suggesting that the prenatal environment plays a role in the pathogenesis of atherosclerosis. In animal models, a restricted or unbalanced maternal diet during gestation can influence susceptibility to atherosclerosis, but the relation in humans between maternal diet during pregnancy and atherogenesis is unknown. Methods and Results-We measured carotid intima-media thickness (IMT) in 216 nine-year-old children whose mothers had participated in a study of nutrition during pregnancy. IMT was greater in boys, in children who were heavier, in those with higher systolic blood pressure, and in those who took less exercise. Increased IMT was associated with a lower maternal energy intake in early (Pϭ0.029) or late (Pϭ0.006) pregnancy, after adjustment for these factors. Mean IMT of children whose mothers were in the lowest quarter of the distribution of energy intake in late pregnancy was 0.027 mm (95% confidence interval, 0.004 to 0.049) greater than that of those whose mothers were in the highest quarter of the distribution. Conclusion-Lower maternal energy intake during pregnancy may increase the susceptibility to atherogenesis of the child. Key Words: carotid arteries Ⅲ atherosclerosis Ⅲ pregnancy Ⅲ diet Ⅲ children A therosclerosis is a progressive condition that begins early in life. Fatty streaks and intimal thickenings, the initial lesions of atherogenesis, have been found in the coronary arteries of infants and children. 1,2 These early lesions are present in the aortas and coronary arteries of many newborn babies and fetuses 3,4 and occur in a distribution similar to that of advanced lesions in adults, 1,3 suggesting a role for the prenatal environment in the pathogenesis of atherosclerosis.Animal models suggest that maternal diet during pregnancy influences susceptibility to atherosclerosis. Rats exposed during gestation to maternal energy-or proteinrestricted diets have an increased incidence of endothelial dysfunction and hypertension. 5-8 Similar outcomes have been observed in the offspring of rats fed a high-fat diet during pregnancy. 9,10 Whether there is any relation in humans between characteristics of maternal diet during pregnancy and atherogenesis is not known, although the observation that maternal hypercholesterolemia during pregnancy is linked with faster progression of early atherosclerotic lesions in children suggests that the type and quantity of fat in the maternal diet may play a role in fetal atherogenesis. 11 High-resolution B-mode ultrasound measurements of carotid intima-media thickness (IMT) are widely used as a marker of early atherosclerosis in adults 12,13 and predict vascular events across a wide age range. 13 Fewer studies have investigated IMT in children, but children who are obese, hypercholesterolemic, or diabetic have an increased IMT. 14 -16 Exposure to cardiovascular risk factors in early life has long-term influences on vascular function, predicting IMT and arterial elas...

Ethnic Differences in Carotid Intima-Media Thickness Between UK Children of Black African-Caribbean and White European Origin

“…34 In the present study, BP (both systolic and diastolic) was a major determinant of cIMT; this is consistent with previous reports of the determinants of cIMT in adults [35][36][37] and in children. 38,39 However, in the present study, low-density lipoprotein cholesterol was unrelated to childhood cIMT, whereas skinfold thickness and triglyceride levels were inversely related. Although earlier studies have suggested that both adult and childhood low-density lipoprotein cholesterol levels are associated with adult cIMT, 40 -42 previous evidence for an association between low-density lipoprotein cholesterol and cIMT in childhood is primarily based on small studies comparing children with and without familial hypercholesterolemia, in whom low-density lipoprotein cholesterol differences are marked.…”

“…56,57 However, in the UK population, South Asians rather than black AfricanCaribbeans have the lowest mean birth weight and the highest prevalence of low birth weight. 58 Maternal factors, particularly maternal cigarette smoking and low maternal energy intake, are associated with increased offspring cIMT 38,59 and need further exploration. Genetic factors could also be important, although their role remains uncertain.…”

Developmental and epigenetic pathways to obesity: an evolutionary-developmental perspective

“…Similarly, there is evidence that variation in maternal nutrition within the usual range of intakes of Western women can affect fetal physiology, size at birth and subsequent endothelial function in childhood. [41][42][43][44] There is a very large body of experimental evidence (for review, see McMillen and Robinson 45 ) relating altered fetal development to later obesity and metabolic compromise. These studies, usually performed in rodents or sheep, typically challenge fetal development by reducing overall maternal nutrition, by specifically reducing maternal protein intake or by administering glucocorticoids to the mother.…”

Epigenetic Epidemiology: The Rebirth of Soft Inheritance

“…Specific aspects of the developmental environment, such as the mother’s diet or her body composition, stress levels, and her level of physical activity, have also been shown to be risk factors for later disease. For example, Gale et al [14] showed that a mother’s energy intake in late pregnancy was related to carotid intima-media thickness (an early marker of vascular disease) in 9-year-old children – an effect amplified by the child’s weight at age 9. As these studies were conducted in an unselected population in a European city, they clearly demonstrate how risk is graded across the spectrum of normal human development.…”