A study published in The BMJ found that pregnant women with diabetes have children who are more likely to develop early-onset cardiovascular disease (CVD; primary endpoint) in childhood or early adulthood. This effect is particularly strong in women with a history of CVD or diabetes-related complications.
This population-based cohort study used Danish national health registries to identify 2,432,000 live-born Danish children without congenital heart disease between 1977 and 2016. Children were followed from birth until the time of first CVD diagnosis, death, emigration, or through December 31, 2016. Offspring were exposed to maternal pregestational diabetes, including type 1 (n=22,055) and type 2 (n=6,537) diabetes, as well as gestational diabetes (n=26,272).
During up to 40 years of follow-up, 1,153 children of mothers with diabetes and 91,311 children of mothers without diabetes were diagnosed with CVD. Offspring of mothers with diabetes had a 29% increased overall rate of early-onset CVD (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.21-1.37).
Both pregestational diabetes (HR, 1.34; 95% CI, 1.25 to 1.43) and gestational diabetes (HR, 1.19; 95% CI, 1.07-1.32) were associated with increased rates of CVD in children.
The rates of specific early-onset CVDs varied: heart failure (HR, 1.45; 95% CI, 0.89-2.35), hypertensive disease (HR, 1.78; 95% CI, 1.50-2.11), deep vein thrombosis (HR, 1.82; 95% CI, 1.38-2.41), and pulmonary embolism (HR, 1.91; 95% CI, 1.31-2.80).
Increased rates of CVD were seen in different age groups from childhood to early adulthood until 40 years, and this was more pronounced among offspring of mothers with diabetes-related complications (HR, 1.60; 95% CI, 1.25-2.05). A higher incidence of early-onset CVD in offspring of mothers with diabetes and comorbid CVD (HR, 1.73; 95% CI, 1.36-2.20) was associated with the added influence of comorbid CVD but not due to the interaction between diabetes and CVD on the multiplicative scale (P=0.94).
“If maternal diabetes does have a causal association with increased CVD rate in offspring, the prevention, screening, and treatment of diabetes in women of childbearing age could help to reduce the risk of CVD in the next generation,” the authors concluded.