Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring

1. Children of mothers with diabetes are more likely to develop cardiovascular disease.

Evidence Rating Level: 2 (Good)

The prevalence of cardiovascular disease (CVD) in children and young adults is increasing. Growing evidence suggests that maternal health during or before pregnancy may impact the development of CVD among offspring. Maternal diabetes is known to be associated with increased risks of metabolic syndrome and congenital heart disease among offspring. The effects on early onset CVD, however, are unknown. In this retrospective cohort study, 2,432,000 live-born children (born between 1977 and 2016) without congenital heart disease were studied to assess the impact of maternal pre-gestational or gestational diabetes on early onset CVD in children. Overall, 2.3% of children were exposed to maternal pre-gestational diabetes and 1.1% were exposed to gestational diabetes. At baseline, mothers with diabetes were more likely to be older, to be more highly educated, to have higher parity, to live alone, and to smoke less during pregnancy than those without diabetes. Furthermore, children exposed to maternal diabetes were more likely to have a parental history of CVD, and to have a higher rate of developing diabetes, obesity, hypertension, hypercholesterolemia, and chronic kidney disease. During the 40 years of follow-up, researchers found that children exposed to maternal diabetes had a higher rate of overall CVD than unexposed children (HR 1.29, 95% CI 1.21 to 1.37). Both pre-gestational diabetes (HR 1.34, 95% CI 1.25 to 1.43) and gestational diabetes (HR 1.19, 95% CI 1.07 to 1.32) were associated with an increased rate of CVD in offspring. These rates were more pronounced in children of mothers with diabetic complications (HR 1.60, 95% CI 1.25 to 2.05). The most common types of CVD were pulmonary embolism (HR 1.91, 95% CI 1.31 to 2.80), deep vein thrombosis (HR 1.82, 95% CI 1.38 to 2.41), and hypertension (HR 1.78, 95% CI 1.50 to 2.11). A sibling comparison analysis of exposed vs. unexposed siblings yielded similar results. Overall, this study indicates that children of mothers with diabetes may be at an increased risk of developing CVD, underlining the importance of diabetes prevention, screening, and treatment in women of child-bearing age.

Click to read the study in BMJ

Image: PD

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