Study links maternal hypertension to higher risk of liver disease in offspring

A study has found that fatty liver disease implications may originate from maternal health and diet during pregnancy, causing long-term implications for children’s and adolescents’ liver health. 

The study investigated associations between prenatal and lifestyle factors by analyzing maternal health during pregnancy and the child’s metabolism, diet, lifestyle, and body composition.

“One of our key findings was that maternal pre-pregnancy hypertension may be associated with elevated alanine aminotransferase (ALT) levels [an enzyme turning protein into energy] in the child, both in childhood and adolescence,” says Hanna de Ruyter, a doctoral researcher at Tampere University, Finland, and lead author of the study.

“This suggests that maternal cardiometabolic health in the prenatal period may contribute significantly to the development of metabolic dysfunction-associated steatotic liver disease (MASLD) in the offspring. However, further studies are required to definitively establish this causal relationship.”

Additionally, the study found that children’s body composition and a shorter duration of exclusive breastfeeding were also linked to higher ALT levels from early childhood.

Maternal health

The study, published in The Journal of Pediatrics, included 736 children and adolescents in Finland. Among them, 488 were aged seven to eight, 421 aged nine to 11, and 255 aged 15–17.

Maternal hypertension was one of the most prevalent indicators of higher ALT levels in children.Maternal hypertension was one of the most prevalent indicators of higher ALT levels in children, the authors note. These findings were independent of gender and body mass index standard deviation score (BMI-SDS).

The average duration of exclusive breastfeeding was three months, and partial breastfeeding averaged seven months. The average age at which babies started to eat solid foods was four months.

The study details that 8.1% of participating women had gestational diabetes mellitus, 2.8% pre-existing diabetes, 1.1% gestational hypertension, 3.1% preeclampsia, 14% smoked, and 4.5% reported consuming alcohol during pregnancy.

The pregnant women suffering from hypertension showed a positive association with their child having higher ALT levels by mid-childhood and adolescence. Smoking was associated with an increase in late childhood and gestational diabetes mellitus in adolescence. The latter two were not associated when adjusting for BMI-SDS.

The researchers linked exclusive breastfeeding for six months, which aligns with the WHO recommendations, and thereby introducing solid foods at an older age, to lower ALT levels in adolescence.

Another study examining children’s health outcomes from maternal nutrition found that exclusive breastfeeding and then transitioning to a healthy diet of solid foods and vitamin D supplementation may lower the risk of overweight and obesity later in childhood.

Last year, Nutrition Insight sat down with experts from Valio and Gnosis by Lesaffre to discuss the importance of maternal nutrition and nutrition for children’s first 1,000 days of life.

Dietary intake during childhood

The researchers investigated which diets may play a role in developing MASLD, linking a high intake of dairy, protein, and animal-based foods to higher ALT levels. They observed the opposite when consuming a diet high in fruits, berries, and vegetables, resulting in lower ALT levels.

Most children in the study were overall healthy with low MASLD levels.Most children in the study were overall healthy with low MASLD levels. However, 10–15% of children had elevated ALT levels, which may lead to the development of metabolic syndrome or liver disease later in life.

Among the children, 13.7–16.6% were overweight or obese, 0.2–0.8% met the MASLD criteria, and 11.7–14.9% showed elevated ALT levels. 

The study did not find any associations between children’s physical activity, fitness, or sleep with ALT levels. 

The authors conclude that the results were modest and reduced when adjusting for the false discovery rate and, therefore, urge caution in interpreting the results. However, they note that the study underscores the importance of pre- and postnatal nutrition and how it influences health later in life.

“While these findings should be interpreted with caution and replicated in other cohorts, the study provides important new insights into the early-life origins of MASLD. The findings may, in time, contribute to the development of preventive strategies that address risk factors even before the onset of liver disease,” says study co-author Kalle Kurppa, professor of Promotion of Pediatric and Adolescent Health at Tampere University.