Middle-class maternal socioeconomic status in pregnancy protects against the risk of worsening cardiac damage in youth: a 24-Year Longitudinal Study

Background Low socioeconomic status is a preventable risk factor for cardiometabolic diseases in adults and pediatric populations. We have established that childhood elevated blood pressure (BP), smoking, dyslipidemia, sedentariness, and hyperglycemia are independent risk factors for premature cardiac damage in mid-twenties. However, whether higher maternal socio-economic status has a cardio-protective effect remains unclear. The rarity of repeated echocardiography measures has left the question unanswered. Purpose To examine if a higher maternal socioeconomic status at 32 weeks gestation longitudinally prevent the risk of worsening structural cardiac damage. Methods From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years were included. Pregnant mothers reported their occupational status during the third trimester of pregnancy. Occupational status was classified based on the British classification of professional (9.8%), managerial (33.8%), skilled (manual and non-manual) (45.2%), partly-skilled (9.6%), and unskilled (1.6%) occupations. Repeated echocardiography measured left ventricular mass indexed for height2.7 (LVMI2.7), was available at ages 17 years and 24 years follow-up. LVMI2.7 ≥51g/m2.7 was categorised as LV hypertrophy, a surrogate marker of early cardiac damage. Multivariable adjusted associations were examined using generalized linear mixed-effect models with logit-link and adjusted for sex, family history of cardiometabolic diseases, and time-varying covariates measured at both baseline and follow-up such as age, heart rate, systolic BP, fat mass, lean mass, smoking status, sedentary time, light physical activity, moderate-to-vigorous physical activity, and fasting low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol glucose, insulin, and high-sensitivity C-reactive protein. Results Among 1595 adolescents, (mean [SD] age at baseline, 17.74 [0.38] years) the prevalence of LV hypertrophy increased from 2.6% to 7.9% over 7 years. In a fully adjusted model, with professional occupation as a reference, managerial, skilled non-manual, and skilled manual occupations were significantly and separately associated with lower odds of worsening LV hypertrophy (odds ratio 0.87 [95% CI, 0.78 – 0.97], p=0.012), (0.89 [0.79 – 0.99], p=0.034) and (0.75 [0.66 – 0.85], p<0.001), respectively. However, unskilled occupation had no statistically significant associations with the risk of cardiac damage across the 7-year cardiac observation period. Conclusion Middle-class maternal socioeconomic status in pregnancy may significantly and independently decrease the odds of worsening cardiac damage during growth from adolescence through young adulthood by 25 percent. Middle-class maternal socio-economic status may be more beneficial to offspring cardiac health than higher maternal socio-economic status, but the potential mechanism warrants further studies.