Table 3.
Impact of pregnancy complications on fetal risks for disease categories up to adulthood (selected prospective, mostly retrospective cohorts, and systematic reviews).
| Pregnancy disease | Sample (n) | Literature (Reference number/year) | Definition of health risk in fetal life as an adult | Association of health risk HR/OR/relative risk (RR)/SD (95% CI) |
|---|---|---|---|---|
| Cardiovascular | ||||
| LBW and famine during gestation | 975 | (53)/2011 | Coronary artery disease | HR 1.9 (1.0 to 3.8) adjusted for sex |
| LBW and first-trimester famine | 726 | (53)/2011 | CHD | OR 3.0 (1.1 to 8.1) age and sex adjusted |
| LBW and famine | 658 | (53)/2011 | Systolic BP | −4.14 mmHg/kg (−7.24 to −1.03) inverse relation |
| Diastolic BP blood pressure | −2.09 mmHg/kg (−3.77 to −0.41) inverse relation | |||
| Prevalence of hypertension | OR 0.67/kg (−0.49 to 0.93) age and sex adjusted | |||
| LBW (SGA) up to HBW (LGA) | 6,239 | (54)/2016 | Left ventricular mass | SD score 0.05 (0.03 to 0.08) p < 0.01 for trend |
| LBW (SGA) up to HBW (LGA) | 6,239 | (54)/2016 | Aortic root diameter | SD score 0.08 (0.05 to 0.1) p < 0.01 for trend |
| Preeclampsia (PE) | 45,249 | (55)/2013 | High systolic BP during child and adulthood | 2.39 mmHg (1.74 to 3.05) |
| High diastolic BP during child and adulthood | 1.35 mmHg (0.90 to 1.80) | |||
| PE | 2,868 | (56)/2015 | Cardiovascular risk, hypertension and metabolic disease (QRISK > 75 P) at age 20 | OR 2.5 (1.32 to 4.56) |
| Prospective cohort | ||||
| Complicated HTN + birth factors | 2,868 | (56)/2015 | Hypertension at age 20 | aOR 6.25 (1.96 to 19.96) |
| Complicated HTN + risks at 20 years | aOR 6.74 (1.25 to 36.29) | |||
| Complicated HTN + social risks | aOR 6.63 (1.17 to 37.57) | |||
| Preterm SGA vs. term | 1,756 | (83)/2015 | Adult hypertension | 36.9 vs. 25.4%; risk factors adjusted p = 0.006 |
| Neurologic | ||||
| First-trimester famine | 66,321 | (53)/2011 | Schizophrenia ICD-6/-9 | OR 2.01 (1.03 to 3.94) |
| First-trimester famine | 737 | (53)/2011 | Accelerated aging, depression | β = −85 (−139 to −32), p = 0.002 |
| First- and second-trimester famine | 100,543 | (53)/2011 | Antisocial personality disorder in men ICD-6 | aOR 2.5 (1.5 to 4.2) |
| Fetal growth restriction | 1,679 | (57)/2008 | Hostility | (beta)SD < −0.05 (−0.14 to 0.00) |
| Metabolic | ||||
| First-trimester famine | 2,414 | (53)/2011 | Increase LDL–high-density lipoprotein cholesterol ratios adult | Increase 13.9% (2.6 to 26.4) |
| LBW | 2,546 | (58)/2016 | Leptin to fat mass ratio, leptin, diabetes mellitus (DM), obesity | p < 0.05 for all, chi-square test or ANOVA |
| Complicated HTN + birth factors | 2,868 | (56)/2015 | Overweight or obesity at age 20 | aOR 1.68 (1.18 to 2.39) |
| Complicated HTN + risks at 20 years | Prospective cohort | aOR 1.62 (1.05 to 2.52) | ||
| Complicated HTN + social risks | aOR 1.59 (1.02 to 2.48) | |||
| Early preterm | 1,358 | (59)/1996 | High insulin at birth | OR 2.05 (1.69 to 2.42) |
| Early preterm | 1,358 | (59)/1996 | High insulin in childhood | OR 1.31 (1.10 to 1.52) |
| Parental smoking | 17,003 | (60)/2014 | Increased body mass index (BMI) and WC at 32 years | Increase of 0.57 kg/m2/1.46 cm (p ≤ 0.02) |
| Birth weight < 2 SD | 61,311 | (61)/2007 | DM as an adult | OR 2.01 (1.39 to 2.91) |
| Birth weight ≥ 2 SD | DM as an adult | OR 2.27 (1.38 to 3.74) | ||
| Famine second trimester | 702 | (62)/2006 | Decreased glucose tolerance at 50/58 years | Diff = 0.4 mmol/l (0.1 to 0.7), sex/BMI adjusted |
| LGA and GDM during pregnancy | 179 | (63)/2005 | Metabolic syndrome at 11 years (increased insulin resistance and obesity) | OR 10.4 (1.5 to 74.4) |
| After ovulation induction | 2,577 | (64)/2014 | Increased fasting glucose levels at 6 years | 0.4 mmol/l (0.2 to 0.6) |
| After in vitro fertilization | 2,577 | (64)/2014 | Increased fasting glucose levels at 6 years | 0.2 mmol/l (0.0 to 0.5) |
a, adjusted; BP, blood pressure; CHD, coronary heart disease; GDM, gestational diabetes mellitus; HR, hazard ratio; HTN, hypertensive disease in pregnancy; LBW, low birthweight; LGA, large for gestational age; OR, odds ratio; SGA, small for gestational age.