Key result
Doubling cord homocysteine linked to ~2.2-fold higher odds of elevated childhood diastolic blood pressure.
Why the study?
High blood pressure tracks from childhood into adulthood, but the effect of prenatal one-carbon metabolism, reflected by umbilical cord homocysteine and folate, on early childhood blood pressure was unknown.
Does prenatal one-carbon metabolism, reflected by umbilical cord and maternal homocysteine and folate levels, affect blood pressure and the risk of high blood pressure in early childhood?
Cohort (n=500)
Does prenatal one-carbon metabolism, reflected by umbilical cord and maternal homocysteine and folate levels, affect blood pressure and the risk of high blood pressure in early childhood?
Higher umbilical cord plasma homocysteine is directly associated with elevated diastolic blood pressure and higher odds of high DBP in early childhood, highlighting prenatal one-carbon metabolism as a potential target for primordial hypertension prevention.
Answers are grounded in this paper and cite their sources.
Cord homocysteine was associated with higher childhood DBP; hypothesis-generating for primordial prevention via one-carbon metabolism, needing prospective confirmation.
BACKGROUND: High blood pressure (BP) tracks from childhood into adulthood, contributing to cardiovascular risk. How the prenatal one-carbon (1-C) metabolism, as reflected by umbilical cord homocysteine and folate, affects BP in early childhood is unknown. METHODS: The prospective population-based birth cohort ENVIRonmental influence ON earlyAGEing (ENVIRONAGE) comprised 500 mother-offspring pairs. Umbilical cord and maternal homocysteine and folate were measured by electrochemiluminescence immunoassay. The association of the offspring BP and risk of high BP was assessed by linear and logistic regression and by mediation analysis. Association sizes were expressed per doubling of the biomarkers and adjusted for the children's sex, age and weight and maternal age at delivery and parity. RESULTS: At 4.5 years (median), cord homocysteine was associated with higher diastolic and mean BP (MBP), but not SBP with association sizes of 1.67 mmHg [95% confidence interval (CI), 0.36-2.99] and 1.19 mmHg (0.01-2.38), respectively. The odds ratio for high childhood DBP with normotension as reference was 2.22 (1.34-3.68). Associations of BP with cord folate were not significant. Cord folate had only an indirect effect on DBP and MBP with effect sizes amounting to -3.04 (P = 0.027) and -2.30 (P = 0.061) mmHg. Maternal biomarkers were not associated with the offspring's BP. CONCLUSION: In this prospective birth cohort study, higher cord plasma homocysteine was associated with higher DBP in early childhood, whereas cord folate was only via homocysteine associated with the offspring's BP. The 1-C metabolism provides a mechanism for preventing high BP in childhood, which is a forerunner of hypertension in adolescence and adulthood.
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Shi et al. (2026) conducted a cohort in Early childhood blood pressure and risk of high blood pressure (n=500). Umbilical cord and maternal plasma homocysteine and folate levels (per doubling) vs. Normotension (reference for high childhood diastolic blood pressure odds ratio) was evaluated on High childhood diastolic blood pressure (alongside continuous diastolic, systolic, and mean blood pressure) (OR 2.22, 95% CI 1.34-3.68). Doubling of umbilical cord homocysteine increased the odds of high childhood DBP (OR 2.22; 95% CI 1.34-3.68) and raised DBP by 1.67 mmHg (95% CI 0.36-2.99).
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