Vascular dysfunction and alteration of novel and classic cardiovascular risk factors in mothers of growth restricted offspring

ObjectiveOffspring and maternal birthweight are inversely associated with maternal cardiovascular disease. However, whether established or putative novel cardiovascular risk factors including vascular and metabolic function are disrupted in women who delivered small for gestational age (SGA) offspring is unknown.MethodsCase control study with analysis of inflammatory, lipid, metabolic and haemostatic markers and microvascular function as assessed by laser Doppler iontophoresis 4 years after the index pregnancy in 28 mothers who delivered SGA offspring at term and 29 matched controls.ResultsDelivery of a SGA infant was associated with altered lipids [triglyceride median (IQR) mmol/l; control 0.64 (0.49-0.84); SGA 0.95 (0.67-0.95), p = 0.012] [cholesterol:HDL ratio: control 2.64 (2.10-3.10); SGA 3.06 (2.65-3.89), p = 0.013], systolic blood pressure [control mmHg: 110 (108-118); SGA 120 (110-130), p = 0.031], subclinical inflammation [CRP mg/l: control 0.7 (0.3-2.1); SGA 2.2 (1.2-4.0), p = 0.002] [IL-6 pg/ml: control 1.2 (0.8-1.4); SGA 1.5 (1.1-2.2), p = 0.009] and endothelial activation [ICAM-1 ng/ml: control 237.7 (210.0-279.4); SGA 283.1 (240.5-366.3), p = 0.013], with differences robust to confounder adjustment. Endothelium dependent (p = 0.003) and independent microvascular function (p < 0.001) were also impaired in mothers of SGA offspring.ConclusionsMothers of term SGA offspring exhibit perturbation of metabolic and vascular function, which may underlie a lifelong trajectory of impaired health incorporating adverse perinatal and cardiovascular events.