Maternal pre-pregnancy BMI, gestational weight gain, and the cardiovascular stress response in the adolescent offspring

Maternal pre-pregnancy overweight and excessive gestational weight gain (GWG) are important risk factors for cardiovascular disorders in offspring. Underlying mechanisms remain unclear, but may involve structural and functional cardiovascular developmental adaptions. To detect subtle cardiovascular adaptations not present at rest, exercise testing can be used. We examined the associations of maternal pre-pregnancy BMI and GWG with the cardiovascular-stress-response in adolescent offspring. Among 180 mother-adolescent-pairs from a population-based prospective cohort from early-pregnancy onwards, we obtained maternal pre-pregnancy BMI and GWG by physical measurements and questionnaires. At 16 years, offspring performed an isometric handgrip exercise with continuous heart rate and blood pressure (BP) monitoring and cardiovascular MRI. Maternal pre-pregnancy overweight was associated with higher adolescent peak systolic BP (compared to maternal normal weight: difference: 0.45SDS, 95% confidence interval:0.12-0.78 SDS), but not with systolic BP at rest or recovery. This association was also present across-the-full-range of maternal pre-pregnancy BMI and not explained by birth characteristics or adolescent BMI. No differences were observed in heart rate or diastolic BP response to exercise by maternal pre-pregnancy BMI across-the-full-range, in clinical categories or by GWG. Higher GWG across-the-full-range, but not maternal pre-pregnancy BMI or excessive GWG, was associated with higher left ventricular stroke volume, ejection fraction, and cardiac index during stress (all p-values<0.05). These associations were not explained by birth characteristics or adolescent BMI. Higher maternal pre-pregnancy BMI and GWG across-the-full-range are associated with higher Systolic BP at peak exercise and an altered cardiac response to exercise in adolescent offspring, respectively. Optimizing maternal weight before and during pregnancy may aid in prevention of cardiovascular risk development in offspring.