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If a woman has heart health factors, such as obesity and smoking while pregnant, her child might end up a decade later with poor heart health, according to a new study from Northwestern Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago.

The study, published in the Journal of the American Medical Association, is the most comprehensive yet to connect multiple heart factors during pregnancy with health issues in adolescents ages 10 to 14.

Studying more than 2,300 mother-child pairs from six countries, the researchers found that among moms who had more than two heart health factors — like obesity, smoking, high blood pressure or cholesterol — their children were nearly eight times more likely to have poor heart health, monitoring factors in the kids like blood pressure, cholesterol and glucose.

"To me, that's a pretty striking finding," said Dr. Amanda Perak, a cardiologist who co-wrote the study. A better understanding of why children have cardiovascular issues can help them avoid heart attacks, strokes and premature deaths, she said.

Perak said they wanted to study the connection between a mom's heart and their children after finding many women have poor heart health during pregnancy. And as a pediatric preventive cardiologist, she often sees children in young adolescence who already have issues like obesity or high cholesterol. Often, those issues only worsen.

"Adults know for themselves that once they've developed obesity or high blood pressure, it's pretty hard to undo that, and unfortunately even in adolescence it's pretty hard," she said.

Heart health among pregnant women has been a concern for maternal health experts. The surgeon general's plan to improve maternal health noted that heart disease is a leading cause of death during pregnancy. Women of color are most vulnerable; the American College of Obstetricians and Gynecologists has noted that Black women are more at risk of dying from cardiovascular diseases than white women.

Previous studies had evaluated single health problems like obesity or high blood pressure during pregnancy, but this study evaluated multiple issues at once, Perak said.

She said if doctors know some babies might be more at risk, they can be more vigilant. "We know those babies need more attention," she said.

It is a good opportunity for further research, she said, for example taking one group of pregnant moms and giving them an intervention for their hearts and for the other half offering usual care, then following both sets of moms and babies.