CV Health in Pregnancy Linked to Developmental Delay in Children

Better maternal cardiovascular health (CVH) during pregnancy was associated with a lower risk of developmental delay in offspring at age 4 years, according to a cohort study published in JAMA Network Open.¹ The findings add developmental delay to a growing list of offspring outcomes linked to maternal CVH and suggest that a readily measurable, modifiable maternal health profile during pregnancy may be associated with early childhood neurodevelopment.

“Developmental delay affects daily living, social functioning, and mental health,” wrote the researchers of the study. “Maternal cardiovascular health during pregnancy may indicate an adverse intrauterine environment, but its association with developmental delay is unclear.”

Researchers analyzed data from 8238 mother-offspring pairs enrolled in a population-based prospective cohort in Japan. Mothers were enrolled between July 2013 and March 2017, with offspring followed for 5 years.

Maternal CVH was assessed using the American Heart Association's Life's Essential 8 (LE8) framework, which scores 8 metrics: diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure, on a 0-to-100 scale. Mothers were categorized as having high (80-100), moderate (50-79), or low (0-49) CVH based on data collected before 32 weeks' gestation.

The primary outcome was developmental delay at age 4, assessed by mothers using the validated Japanese version of the Ages and Stages Questionnaire, Third Edition (ASQ-3), which screens 5 domains: communication, gross motor, fine motor, problem-solving, and personal-social skills. Delay in any single domain qualified a child for "developmental delay in total."

Low CVH Nearly Doubled Developmental Delay Risk

Among the 8238 mothers, 21.3% had high CVH, 76.4% had moderate CVH, and 2.4% had low CVH during pregnancy. Developmental delay in total occurred in 8.8% of offspring born to mothers with high CVH compared with 12.1% among those with moderate CVH and 16.8% among those with low CVH.

After adjustment using inverse probability of treatment weighting, moderate CVH (risk ratio [RR], 1.30; 95% CI, 1.09-1.54) and low CVH (RR, 1.62; 95% CI, 1.11-2.36) were each associated with significantly higher risk of developmental delay in total compared with high CVH (P for trend < .001).

Low CVH was linked to elevated risk across all 5 ASQ-3 domains. The personal-social domain showed the largest effect size (RR, 2.23; 95% CI, 1.23-4.07; P for trend = .002), the communication domain showed the smallest effect size, and the comparison between low and high CVH was not statistically significant despite a significant overall trend across CVH categories.

Cubic spline modeling showed the association between CVH score and developmental delay was not linear: risk dropped sharply below a CVH score of 50, leveled off between roughly 50 and 60, and then declined more steeply again above 70 to 80—suggesting that the association may not follow a strictly linear dose-response pattern.

The findings held up across a series of sensitivity analyses, including alternative gestational age landmarks, restriction to term births only, adjustment for gestational age at delivery, and recalculating CVH scores with individual components removed one at a time, suggesting the observed association was robust to several alternative analytic approaches and was not fully explained by any single LE8 component or by preterm birth.

The researchers noted several limitations. Only 43% of eligible pairs had complete data, and excluded participants differed systematically, raising selection bias concerns, although a sensitivity analysis produced similar results. Developmental delay relied on maternal report rather than clinician evaluation, and the cohort was drawn from a single Japanese prefecture, limiting generalizability.

The findings build on prior research linking maternal CVH during pregnancy with adverse pregnancy outcomes and CVH measures in offspring. Related research has similarly tied maternal cardiometabolic risk factors during pregnancy to elevated offspring blood pressure through adolescence, reinforcing the broader pattern of maternal cardiometabolic status shaping long-term child health trajectories well beyond the cardiovascular system itself.²

Together, these findings suggest maternal CVH may serve as a useful, modifiable marker associated with multiple domains of offspring health.

“In this cohort study of mother and offspring pairs in Japan, better maternal CVH during pregnancy was associated with a lower risk of offspring developmental delay at age 4 years,” wrote the researchers.

References

1. Ohseto H, Ishikuro M, Chen G, et al. Maternal cardiovascular health during pregnancy and offspring developmental delay. JAMA Netw Open. 2026;9(6):e2618804. doi:10.1001/jamanetworkopen.2026.18804
2. Niu Z, Ako AA, Geiger SD, et al. Maternal cardiometabolic risk factors in pregnancy and offspring blood pressure at age 2 to 18 years. JAMA Netw Open. 2025;8(5):e259205. doi:10.1001/jamanetworkopen.2025.9205