Obesity, Diabetes, & High Blood Pressure Before and During Pregnancy are Associated with Higher Blood Pressure in Children

Authors: Zhongzheng Niu, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

High blood pressure in childhood is linked to a higher risk of experiencing high blood pressure and other heart-related complications later in life. Preventing high blood pressure during childhood could be a promising strategy to improve cardiovascular health into adulthood. Growing evidence suggests that maternal health during pregnancy may be a contributor. For this study, researchers wanted to look at how three common cardiometabolic risk factors— pre-pregnancy obesity, gestational diabetes, and high blood pressure (hypertension) during pregnancy—are related to blood pressure in their children between ages 2 and 18.

What were the study results?

A new finding from this study is that when mothers had more than one health issue during pregnancy—especially when high blood pressure occurred alongside gestational diabetes or pre-pregnancy obesity—their children’s blood pressure was higher than when the mother had only one of these conditions. Of the mothers included in this study, 44% had at least one cardiometabolic risk factor during pregnancy. The most common was pre-pregnancy obesity at 26%, followed by high blood pressure at 14% and gestational diabetes at 7.3%. Children whose mothers had any of these health issues during pregnancy had higher average blood pressure when compared to those born to mothers who did not. This was true for the top (systolic) and the bottom (diastolic) numbers in a blood pressure reading, even after accounting for the child’s age, sex, and height. These children also showed an increased rate of blood pressure change between ages 2 and 18. The association was stronger for diastolic blood pressure in female children and for systolic blood pressure in non-Hispanic Black children whose mothers had gestational diabetes or high blood pressure during pregnancy.

What was this study's impact?

This study can help researchers and clinicians better understand how a mother’s heart and metabolic health during pregnancy may influence a child’s long-term cardiovascular health. This highlights the potential value of early-life interventions aimed at monitoring and managing blood pressure in children with prenatal exposure to these maternal risk factors.

Who was involved?

The research included 12,480 mother-child pairs from study sites in the ECHO program. The mother's average age at pregnancy was 30 years, and 47% of participating mothers were non-White. At least one maternal cardiometabolic risk factor was present in 44% of the mothers.

What happened during the study?

Researchers gathered information about mothers’ heart and metabolic health from medical records or surveys. They also collected blood pressure readings from their children, either during study visits or from their medical records. They used statistical methods to look at how a mother’s health before and during pregnancy might be linked to her child’s blood pressure—both at the youngest age and as the child grew from age 2 to 18. They also looked at whether these links were different depending on the child’s sex or race and ethnicity.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

More research could help researchers understand how combinations of maternal cardiometabolic risk factors influence children’s blood pressure over time. Future studies could also examine how structural and social factors contribute to maternal health during pregnancy and shape long-term cardiovascular health in children.

Where can I learn more?

Access the full journal article, titled “Maternal cardiometabolic risk factors in pregnancy and offspring blood pressure at age 2-18 years,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published May 08, 2025

Access the associated press release.

Download this summary

Obesity, Diabetes, & High Blood Pressure Before and During Pregnancy are Associated with Higher Blood Pressure in Children

Maternal Cardiometabolic Health During Pregnancy Associated with Higher Blood Pressure in Children, NIH Study Finds

Posted on May 8, 2025August 27, 2025 by Jodi Snare

Children born to mothers with cardiometabolic health issues before or during pregnancy may face a higher risk of elevated blood pressure in childhood and adolescence, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health (NIH).

High blood pressure in childhood often continues into adulthood and is linked to a greater risk of heart problems later in life. This ECHO research offers insights into how a mother’s heart and metabolic health before and during pregnancy may contribute to her child’s long-term cardiovascular well-being.

The study analyzed data from 12,480 mother-child pairs in the ECHO Program. Researchers looked at how three maternal cardiometabolic risk factors—pre-pregnancy obesity, gestational diabetes, and high blood pressure during pregnancy—were related to children’s blood pressure from ages 2 to 18.

Key Findings:

44% of mothers in the study had at least one cardiometabolic risk factor during pregnancy.

Children whose mothers had more than one condition, such as gestational diabetes combined with high blood pressure or pre-pregnancy obesity, had higher blood pressure than those whose mothers had only one condition.
Children born to these mothers had higher average blood pressure readings, even after accounting for age, sex, and height of the child.

These children also experienced an increased rate of change in blood pressure over time, suggesting a long-term impact.

The effect was especially strong for diastolic blood pressure in girls and systolic blood pressure in non-Hispanic Black children whose mothers had gestational diabetes or high blood pressure.

“With declines in cardiometabolic health, it’s important to focus on prevention starting as early as possible,” said ECHO researcher Zhongzheng Niu, PhD, of the Keck School of Medicine at the University of Southern California. “Our study suggests that helping people improve their health before and during pregnancy could benefit both mothers and future generations."

The researchers in this study call for further studies to understand how combinations of maternal health issues and broader social and structural factors contribute to these long-term risks.

This collaborative research is published in JAMA Network Open.

Niu, Z. Maternal Cardiometabolic Risk Factors in Pregnancy and Offspring Blood Pressure at Age 2-18 Years. JAMA Network Open, DOI: 10.1001/jamanetworkopen.2025.9205.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X.

NIH Study Finds Association Between Gestational Diabetes, Maternal Depression, and Early Childhood Behavior Problems

Posted on May 12, 2023August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Gestational diabetes, prenatal depression, and postpartum depression were each individually associated with higher levels of early childhood behavior problems such as attentional problems, anxiety, and depression in new research funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Previous research has linked gestational diabetes to prenatal and postpartum depression. Researchers wanted to determine how that combination of maternal symptoms affected early childhood behaviors.

“Our findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy could benefit from receiving additional monitoring for behavioral problems during early childhood,” said Lauren Shuffrey, PhD, an ECHO Program investigator at Columbia University.

The researchers also found that gestational diabetes was associated with autism-related behaviors only in children whose mothers reported higher levels of depressive symptoms during and immediately after pregnancy. Gestational diabetes was also associated with child behavioral problems only in male children.

This study included 2,379 children from ECHO research sites in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers who were diagnosed with gestational diabetes.

During this study, ECHO researchers collected information from the participating mothers, including gestational diabetes diagnosis and self-reports of depression symptoms during and after pregnancy. To investigate the effect of these maternal conditions on child behavior, the researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5 years old.

Dr. Shuffrey led this collaborative research published in Child Development.

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

ECHO Researchers Investigate Associations Between Gestational Diabetes, Perinatal Maternal Depression, and Early Childhood Behavioral Problems

Posted on May 9, 2023December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Lauren C. Shuffrey, PhD of Columbia University investigates the effects of gestational diabetes, a type of diabetes that mothers develop during pregnancy, prenatal depression, and postpartum depression on early childhood behavior. This study found gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each independently linked to higher levels of externalizing and internalizing behavior problems during early childhood. The study also found that gestational diabetes was only associated with autism-related behaviors when children were exposed to higher levels of perinatal maternal depressive symptoms. Finally, maternal gestational diabetes was only associated with child behavioral problems for male children.

This research, titled “Association of Gestational Diabetes Mellitus and Perinatal Maternal Depression with Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” is published in Child Development.

Although previous research has shown associations between gestational diabetes and pre- and postnatal depression in mothers, prior studies have not determined if the combination of these conditions affect child behavioral outcomes.

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of child participants (52%) were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as Mixed Race, and 4% as Asian.

In this study, ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5 years old. The researchers also collected information from the mothers, including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

“Our findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy could benefit from receiving additional monitoring for behavioral problems during early childhood,” said Dr. Shuffrey. “Future research should investigate potential biological mechanisms underlying associations between gestational diabetes, maternal depression, and early childhood behavioral outcomes.”

Read the research summary.

NIH Study Reveals Potential Link Between Pregnancy Complications and Slower Infant Development

Posted on February 24, 2023August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Gestational diabetes and preeclampsia may be linked to slower biological development in infants, according to a new study funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

The study found that newborns who were exposed to these two pregnancy complications were biologically younger than their chronologic gestational age—an effect that was most noticeable in female infants. The results provide an important clue about how these common pregnancy complications may affect infants and health outcomes later in childhood.

“In the future, we plan to continue our research with a larger sample of participants and investigate whether these biological changes detected at birth are linked to health outcomes later in childhood,” said Carrie Breton, ScD, MPH, an ECHO Program investigator at the University of Southern California. “If so, doctors and researchers could use that knowledge to develop targeted interventions that can reduce the adverse effects of preeclampsia and gestational diabetes on children’s health.”

During the study, ECHO researchers collected DNA samples from 1,801 newborns from 12 ECHO cohorts across the United States. They used these samples to evaluate each infant’s epigenetic age. Epigenetic age is a pattern of chemicals in the blood that reflects biological age rather than just chronological age. Researchers then compared the epigenetic age to the infant’s chronological age at birth (measured in pregnancy weeks).

Dr. Breton and Christine Ladd-Acosta, PhD, an ECHO Program investigator from Johns Hopkins Bloomberg School of Public Health, led this collaborative ECHO research published in JAMA Network Open.

Ladd-Acosta, C. et al. Analysis of Pregnancy Complications and Epigenetic Gestational Age of Newborns. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.0672

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

ECHO Researchers Investigate Link Between Pregnancy Complications and Infant Development

Posted on February 24, 2023December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Carrie Breton, ScD, MPH of the University of Southern California and Christine Ladd-Acosta, PhD of Johns Hopkins University found that preeclampsia and gestational diabetes may be linked to slower biological development in infants. The researchers found that newborns who were exposed to these pregnancy complications were biologically younger than those without exposure—an effect that was most noticeable in female infants. The results of this study provide an important clue about how biological mechanisms in offspring might be affected by common pregnancy complications and how these conditions could be linked to child health outcomes. This research, titled “Analysis of Pregnancy Complications and Epigenetic Gestational Age of Newborns,” is published in JAMA Network Open.

The study included 1,801 children born between 1998 and 2008 from 12 ECHO cohorts across the United States. ECHO researchers calculated each infant’s epigenetic age—a measurement of their “biological age” based on molecular markers in their cells—using DNA samples collected at birth and compared their biological age to their actual age at birth (measured in pregnancy weeks). Then, the researchers compared the biological ages of newborn babies exposed to pregnancy complications to the biological ages of babies who were not exposed.

“In the future, we plan to continue our research with a larger sample of participants and investigate whether these biological changes detected at birth are linked to health outcomes later in childhood,” said Dr. Breton. “If so, doctors and researchers could use that knowledge to develop targeted interventions that can reduce the adverse effects of preeclampsia and gestational diabetes on children’s health.”

Read the research summary.

New Diabetes Research and Three Major Milestones for the ECHO Program

Posted on November 21, 2022April 3, 2025 by Jodi Snare

November is National Diabetes Month. Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. It can lead to health problems related to your eyes, kidneys, nerves, and heart, and is linked to some types of cancer. Gestational diabetes is diabetes that first appears during pregnancy. This month’s Connector Research Spotlight showcases a recent ECHO study that explores how gestational diabetes, and prenatal depression might be associated with a person’s risk for developing postpartum depression.

Also, around this time each year, I find myself reflecting on how far the ECHO Program has come and where we are heading. I am pleased to announce three major milestones for our program.

First, de-identified data from the ECHO Program are now available as a resource for the entire scientific community. This first public-use version of ECHO-wide Cohort data covers information that our 69 cohort studies collected from 41,299 participants. This momentous step fulfills both a key strategic goal of the ECHO Program and an obligation to U.S. taxpayers for their investment in our research. You can learn more about this data set and how researchers can request access to it in November’s Connector.

Second, our investigators have now published in medical journals more than 1,000 papers about their ECHO research. These publications cover a wide range of topics in child health, and demonstrate how ECHO research is filling evidence gaps on the long-term influences of prenatal and early childhood factors on child and adolescent health. I invite you to visit our ECHO publication database to explore any of these papers.

Finally, we released 7 new Cohort Funding Opportunity Announcements (FOAs) to invite applications to extend and expand the ECHO Cohort to further investigate the influences of a broad range of early exposures from society to biology, including the preconception period, across ECHO’s five key child health outcome areas among diverse populations. I look forward to the next phase of ECHO, and to continued partnership with all of you in our mission to enhance the health of children for generations to come.

ECHO Researchers Examine Associations Between Gestational Diabetes, Prenatal Depression, and Postpartum Depression

Posted on October 10, 2022December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Lauren C. Shuffrey, PhD of Columbia University examines the effects of gestational diabetes, a type of diabetes that develops during pregnancy, and prenatal depression on a person’s risk for developing postpartum depression. The study found that people with gestational diabetes were more likely to be classified as having prenatal depression. Those with both gestational diabetes and prenatal depression were at an increased risk for postpartum depression. But gestational diabetes on its own, without prenatal depression, was not associated with increased risk for postpartum depression.

This research, titled “Gestational Diabetes Mellitus, Prenatal Maternal Depression, and Risk for Postpartum Depression: An Environmental Influences on Child Health Outcomes (ECHO) Study,” is published in BMC Pregnancy and Childbirth.

Previous research has yet to examine the association between the combination of gestational diabetes and prenatal maternal depression and postpartum depression. To address this question, the researchers looked at data from 5,822 participants in 16 ECHO cohorts across 13 U.S. states and Puerto Rico. A total of 4,606 participants had neither gestational diabetes nor prenatal maternal depression, 416 had gestational diabetes only, 689 had prenatal maternal depression only, and 111 had both gestational diabetes and prenatal maternal depression. Participants self-reported on their depression symptoms during and after pregnancy using the PROMIS-D (Patient-Reported Outcomes Measurement Information System) scale. The researchers used this data to evaluate the relationships between maternal depression symptoms and gestational diabetes.

“Our findings underscore the importance of universal depression screening during pregnancy and in the first postpartum year,” said Dr. Shuffrey. “Future studies should examine potential biological mechanisms underlying the relationship between gestational diabetes and maternal depression.”

The ECHO program is currently working towards analyzing blood samples collected during pregnancy to identify potential factors involved in the relationship between gestational diabetes, prenatal depression, and postpartum depression.

Read the research summary.

Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

<< Back to Research Summaries

Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

Author(s): Lauren Shuffrey, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

The study found that participants with gestational diabetes were more likely to be classified as having prenatal depression compared to those without gestational diabetes. Participants with both gestational diabetes and prenatal depression had an increased risk of developing postpartum depression. But gestational diabetes on its own, without prenatal maternal depression, was not linked to an increased risk of postpartum depression.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

These findings underscore the importance of universal depression screenings during pregnancy and for at least a year following birth.

Why was this study needed?

There is a lack of research into how the combination of gestational diabetes (a type of diabetes that develops during pregnancy) and prenatal depression affects a person’s risk for postpartum depression.

Who was involved?

This study included 5,822 participants from 16 ECHO cohorts across 13 U.S. states and Puerto Rico. A total of 4,606 participants had neither gestational diabetes nor prenatal depression, 416 had gestational diabetes only, 689 had prenatal maternal depression only, and 111 had both gestational diabetes and prenatal maternal depression.

What happened during the study?

Researchers collected information from the participants including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The researchers then used that data to evaluate the relationship between gestational diabetes, prenatal depression, and postpartum depression.

What happens next?

Future studies should examine potential mechanisms underlying the relationship between gestational diabetes, prenatal depression, and postpartum depression. The ECHO Program is currently working towards analyzing blood samples collected during pregnancy to identify potential factors involved in this relationship.

Where can I learn more?

Access the full journal article, titled “Gestational Diabetes Mellitus, Prenatal Maternal Depression, and Risk for Postpartum Depression: An Environmental Influences on Child Health Outcomes (ECHO) Study” in BMC Pregnancy and Childbirth.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 8, 2022

Access the associated article.

Download this summary

Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

ECHO Investigators Find Association Between Prenatal Obesity and Child Autism-related Behaviors

Posted on April 20, 2022December 5, 2023 by Jodi Snare

Collaborative ECHO research from Kristen Lyall, ScD of Drexel University and Christine Ladd-Acosta, PhD of Johns Hopkins University found an association between childhood autism-related social behaviors and maternal obesity and gestational diabetes during pregnancy.

The researchers examined the link between child social development and a variety of maternal prenatal conditions—including obesity, gestational diabetes, gestational hypertension, and preeclampsia. Their research, titled “Cardiometabolic pregnancy complications in association with autism-related traits as measured by the Social Responsiveness Scale in ECHO,” is published in the American Journal of Epidemiology and aims to help better understand how a variety of risk factors during pregnancy relate to complex developmental outcomes, such as autism-related traits.

“Just like intelligence scores or height can be plotted on a curve representing everyone’s values ranging from low to high, social functioning and behaviors can also be measured and scored along a similar distribution,” said Dr. Lyall. “Investigating how exposures, health conditions, and risk factors relate across the full range of the outcome distribution may help us learn more about the nature of these relationships and their impact on the population.”

The study involved nearly 7,000 participants from 40 ECHO cohorts, including eight cohorts that had participants with increased likelihood of autism. The researchers collected data on maternal health conditions during pregnancy, maternal age, child autism-related social behaviors, and participant demographics.

Maternal obesity and gestational diabetes are common prenatal conditions, so understanding the impacts of these conditions on children development is an important public health issue. “This work shows that these conditions are not only linked with diagnoses of autism and other developmental conditions, but also subtler changes in related behavioral scores,” said Dr. Ladd-Acosta. “These results highlight the need for better prenatal care and more monitoring of women experiencing conditions like obesity during pregnancy.”

More work is needed in the future to reveal the specific mechanisms linking maternal prenatal health to childhood autism-related social development.

Read the research summary.