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Am J Epidemiol. 2019 Sep 9. pii: kwz181. doi: 10.1093/aje/kwz181. [Epub ahead of print]

Early Life Predictors of Systolic Blood Pressure Trajectories from Infancy to Adolescence: Findings from Project Viva.

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Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore.
Obstetrics and Gynecology Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.


Childhood blood pressure (BP) is a strong predictor for later cardiovascular risk. However, few studies have assessed dynamic BP trajectories throughout the early life period. We investigated the relationship between early life factors and systolic BP (SBP) from infancy to adolescence using linear spline mixed-effect models among 1370 children from Project Viva, a Boston-area cohort recruited in 1999‒2002. After adjusting for confounders and child height, we observed higher SBP in children exposed to gestational diabetes [vs. normoglycemia‒at 3 years: β 3.16mmHg (95% confidence interval 0.28,6.04); 6 years: 1.83mmHg (0.06,3.60)], hypertensive disorders of pregnancy [vs. normal maternal BP‒at 6 years: 1.39mmHg (0.10,2.67); 9 years: 1.84mmHg (0.34,3.34); 12 years: 1.70mmHg (0.48,2.92)], higher neonatal SBP [per 10mmHg increase‒at 3 years: 1.26mmHg (0.42,2.09); 6 years: 1.00mmHg (0.49,1.51); 9 years: 0.75mmHg (0.17,1.33)] and formula milk in the first 6 months [vs. breastmilk only‒at 12 years: 2.10mmHg (0.46,3.74); 15 years: 3.52mmHg (1.40,5.64); 18 years: 4.94mmHg (1.88,7.99)]. Our findings provide evidence of programming of offspring SBP trajectories by gestational diabetes, hypertensive disorders of pregnancy and formula milk intake, and of neonatal BP being a potentially useful marker of childhood BP. These factors could be relevant in identifying children who are at risk of developing elevated BP.


developmental programming; pregnancy; risk factors; systolic blood pressure; trajectories


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