Pre- and Perinatal Correlates of Ideal Cardiovascular Health during Early Childhood: A Prospective Analysis in the Healthy Start Study

J Pediatr. 2021 Jul:234:187-194. doi: 10.1016/j.jpeds.2021.03.014. Epub 2021 Mar 16.


Objectives: To characterize prevalence of ideal cardiovascular health (ICVH) during early childhood (4-7 years of age), and to identify pre- and perinatal biological, sociodemographic, metabolic, and behavioral correlates of ICVH.

Study design: Among 350 mother-child pairs in the Healthy Start Study, we defined ICVH as no exposure to second hand smoke; ≥1 hour/day of moderate-to-vigorous physical activity; body mass index ≤85th percentile; systolic and diastolic blood pressure <90th percentile; cholesterol <170 mg/dL, fasting glucose <100 mg/dL; and healthy diet, per the American Heart Association. Pre- and perinatal characteristics were obtained from questionnaires, medical records, and in-person visits. Because of low prevalence of ICVH, we focused on prevalence of meeting ≥6 metrics in the analysis. We examined bivariate associations of each characteristic with % meeting ≥6 metrics and included those that were significant (P < .05) in a multivariable logistic regression model.

Results: ICVH prevalence at mean ± SD age 4.7±0.6 years was 6.9%; boys had twice the prevalence as girls (9% vs 4.4%). Most (>85%) children met criteria for second hand smoke, body mass index, blood pressure, cholesterol, and glucose, and only one-third met criteria for physical activity (31.4%) and diet (35.1%). In multivariable analyses, key correlates of ICVH were maternal weight status (ORoverweight/obese vs nonoverweight/obese = 0.41 [0.23, 0.73]) and offspring sex (ORmale vs female = 2.14 [1.22, 3.65]).

Conclusions: At age 4-7 years, ICVH prevalence is already low, with diet and adequate physical activity being the limiting factors. Healthy maternal weight prior to pregnancy and male sex are potential determinants of childhood ICVH. Additional work is required to explore associations of early-life ICVH with future health outcomes.

Keywords: cardiometabolic biomarkers; childhood obesity; ideal cardiovascular health.

MeSH terms

  • Adult
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Child
  • Child Health / statistics & numerical data*
  • Child, Preschool
  • Diet, Healthy / statistics & numerical data
  • Exercise
  • Female
  • Health Behavior
  • Health Status*
  • Health Surveys
  • Heart Disease Risk Factors*
  • Humans
  • Logistic Models
  • Male
  • Pregnancy
  • Prenatal Exposure Delayed Effects*
  • Prospective Studies
  • Protective Factors
  • Risk Factors
  • Tobacco Smoke Pollution / adverse effects
  • Tobacco Smoke Pollution / statistics & numerical data


  • Tobacco Smoke Pollution