Higher risks among moms with both diabetes and cardiovascular disease themselves
Children whose mothers had diabetes -- including but not limited to gestational diabetes -- showed increased risk of heart disease, a Danish cohort study spanning 40 years found.
Rates of cardiovascular disease (CVD) ran 29% higher among children of women with diabetes during pregnancy (95% CI 21%-37%) compared with unexposed children, reported Guoyou Qin, PhD, of Fudan University in Shanghai, and colleagues. The risk was especially high in children whose mothers had diabetes prior to becoming pregnant.
Prenatal exposure to maternal diabetes has been linked with obesity and diabetes in children, and that could lead to a risk of CVD later in life, the authors noted in The BMJ.
"The offspring of mothers with diabetes also have a higher prevalence of metabolic syndrome and other risk factors for future [CVD]," they wrote, adding that it is not clear if this means that prenatal exposure to diabetes increases the risk of CVD over a lifetime.
They speculated on potential mechanisms for this association, writing that large amounts of maternal glucose cross the placenta, potentially leading to the increased fetal insulin secretion and hyperinsulinemia as well as hyperglycemia.
"Exposure to [hyperinsulinemia] and [hyperglycemia] in utero could have longlasting effects on fetal vascular gene expression and result in changes in vascular function, thereby contributing to higher CVD risks in offspring," the authors wrote. "Several human studies have shown that the diabetic intrauterine environment could have a programming effect on fetal vascular dysfunction, leading to a poor CVD risk profile after birth."
Researchers examined data from over 2 million children in Danish national health registries who were born without congenital heart disease from 1977 to 2016. They were followed until diagnosis of CVD, death, emigration, or the end of 2016.
About 22,000 women with pregestational diabetes (including type 1 diabetes), about 6,500 with type 2 diabetes, and about 26,200 with gestational diabetes were included in the study. Mothers with diabetes tended to be older, better educated, and to smoke less during pregnancy versus mothers without diabetes, the authors said.
Children of mothers with diabetes were more likely to have a parental history of CVD, and a higher rate of developing diabetes, obesity, hypertension, hypercholesterolemia, and chronic kidney disease.
Overall, 1,153 children of mothers with diabetes developed CVD compared with 91,311 children whose mothers did not have diabetes. Notably, there was a higher rate of early onset CVD among children whose mothers had pre-gestational diabetes (HR 1.34, 95% CI 1.25-1.43) or gestational diabetes (HR 1.19, 95% CI 1.07-1.32).
Children whose mothers had diabetes had the highest risks of pulmonary embolism, deep vein thrombosis, and hypertensive disease. Not surprisingly, children whose mothers had diabetes and CVD had a higher risk of CVD themselves (HR 1.73, 95% CI 1.36-2.20).
Study limitations included unmeasured confounders, live birth selection bias, and misclassification bias.
"We need to monitor CVD risks in offspring of mothers with diabetes and investigate possible life course interventions that could reduce the occurrence of CVD," the authors concluded. "A history of CVD or diabetic complications in women with diabetes should be taken into account in designing public health strategies that target offspring at increased risk of early onset CVD."
The study was supported by the Lundbeck Foundation, the Danish Council for Independent Research and Independent Research Fund Denmark, the Nordic Cancer Union, the Karen Elise Jensens Fond, the Novo Nordisk Foundation, the Danish Centre for Strategic Research in Type 2 Diabetes Project and the Program for Clinical Research Infrastructure established by the Lundbeck Foundation and the Novo Nordisk Foundation, the National Natural Science Foundation of China, the National Center for Advancing Translational Science at NIH, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
The authors disclosed no relevant relationships with industry.
Source Reference: Yu Y, et al "Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up" BMJ 2019; DOI: 10.1136/bmjl6398.
Read the original article on Medpage Today: Mom's Diabetes Tied to Heart Disease in Kids Years Later