Sunday, April 30, 2023

Heart disease in children.. The risk begins long before birth?



the intergenerational impact of heart health before pregnancy:

This is the hypothesis of these experts from the American Heart Association (AHA) who summarize, here in the journal Circulation, the intergenerational impact of heart health before pregnancy. While this impact of maternal health during the period preceding pregnancy is already documented as critical on the metabolic level, this synthesis of the literature shows that the same is true for the influence of the cardiovascular health of pregnant women on that of pregnant women. of their unborn children.

alter the trajectory of cardiovascular risk for both the mother:

Thus, the biological processes leading to pregnancy complications often begin before pregnancy; therefore, interventions that begin after conception could miss the opportunity to alter the trajectory of cardiovascular risk for both the pregnant mother and her child. This review therefore suggests increasing public health interventions to optimize cardiovascular health before pregnancy, particularly among women from higher-risk communities.

Preventing heart disease starts much earlier:

Much earlier than doctors thought, until this scientific statement from the AHA: "Optimizing cardiovascular health before pregnancy to improve outcomes in pregnant and postpartum women, and their offspring." This summary of available data linking a woman's heart health to the heart health of her children also underscores the need for further research into the impact of women's preconception health on the health of their future children.

“Biological processes that contribute to adverse pregnancy outcomes begin before a woman becomes pregnant,”
summarizes Dr. Sadiya S. Khan, professor of cardiology and preventive medicine at the Feinberg School of Medicine at Northwestern University (Chicago).

Pre-pregnancy health status:

key factors considered to assess cardiovascular health are based on the AHA's "Life's Essential 8", namely, a heart-healthy diet, regular physical activity, not smoking , maintain a healthy weight, monitor blood pressure, blood cholesterol and blood sugar, and have healthy sleep. Based on this score, the analysis reveals that:
  • only 1 in 5 women have optimal cardiovascular health.
 

Poor cardiovascular health before conception and pregnancy complications:

these complications include premature delivery, gestational diabetes, high blood pressure, preeclampsia or low height for gestational age. These pregnancy complications are also linked to a higher risk of cardiovascular disease in children: thus,
  • premature birth is associated with a 53% increased risk of heart disease by age 43;
  • Type 2 diabetes before conception is associated with a 39% increased risk of cardiovascular disease in children by age 40.
 

While these results "speak" for themselves, the evidence establishing:

If these results “speak” for themselves, the evidence establishing a link between the health of women before pregnancy and the health of their children remains very limited. Experts are therefore calling for large trials to test whether improving overall cardiovascular health before pregnancy could reduce pregnancy complications, the incidence of death and cardiovascular disease in the general population.

And the way of life? The analysis also raises the issue of prevention and treatment of cardiovascular disease through lifestyle changes such as adherence to a heart-healthy diet and regular physical activity, including among pregnant women. . Long-term studies should also be conducted on the subject.

Psychological health, stress and resilience:

Psychological health, stress and resilience should not be neglected in pregnant women, even before conception. There is a lack of interventions for the poorest women, who do not have access to health care and support. Research shows that long-term stressors like discrimination add an additional level of cardiovascular risk.

In conclusion, there remains a colossal margin for improvement in the health of young mothers, with a window of intervention that opens well before conception: "The period preceding pregnancy offers a unique window of opportunity to equitably prevent increased incidence of adverse pregnancy outcomes, and to interrupt this intergenerational cycle of poor cardiovascular health”.