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12-05-2019 | Cardiovascular disorders | News

Children of mothers with diabetes may have elevated CVD risk

medwireNews: Children born to mothers with diabetes have a higher risk for early-onset, non-congenital cardiovascular disease (CVD) in childhood and early adulthood than those born to mothers without diabetes, suggest findings from a large observational study.

If this association is causal, “the prevention, screening, and treatment of diabetes in women of childbearing age could help to reduce the risk of CVD in the next generation,” say the study authors.

Guoyou Qin (Fudan University, Shanghai, China) and colleagues analyzed CVD risk in 2,432,000 offspring born alive and without congenital heart disease in Denmark between 1977 and 2016. In all, 2.3% of babies were born to mothers with diabetes; 0.9% were exposed to type 1 diabetes, 0.3% to type 2 diabetes, and 1.1% to gestational diabetes. CVD outcomes were defined using international classification of diseases codes, and included hypertensive diseases, ischemic heart disease, cerebrovascular disease, surgical and percutaneous coronary interventions, deep vein thrombosis, and pulmonary embolism.

As reported in The BMJ, the 54,864 offspring born to mothers with diabetes had a significant 29% higher risk for developing CVD over a maximum follow-up of 40 years than the 2,377,136 children born to mothers without diabetes after adjustment for factors including sex, parity, maternal smoking, and maternal age.

CVD was diagnosed in a total of 1153 children born to mothers with diabetes and 91,311 mothers without, and the adjusted cumulative incidence rates were 17.79% and 13.07%, respectively.

This association remained significant when the analysis was broken down by different types of diabetes, with type 1, type 2, and gestational diabetes conferring a corresponding 31%, 39%, and 19% elevated risk for CVD. Similarly, the investigators say that CVD risk among people exposed to maternal diabetes tended to be elevated in all age groups in childhood and adolescence (0–9, 10–14, and 15–19 years) as well as in early adulthood (20–40 years), “regardless of the type of maternal diabetes.”

They also note that rates of “most specific types of CVD,” including hypertensive disease, pulmonary embolism, and deep vein thrombosis, were significantly elevated among people born to mothers with diabetes.

Qin and team found that the increased CVD risk was especially pronounced among people born to mothers with diabetes and comorbid cardiovascular disease and those born to mothers with diabetic complications, with these groups having a 73% and 60% elevated risk, respectively, relative to the no diabetes group.

“The greater effect of coexisting maternal CVD and maternal diabetes on CVD risk in offspring requires additional research to examine the burden of multimorbidity during pregnancy,” write the study authors.

And they conclude that future investigations “should examine the degree of glycaemic control during pregnancy that would minimise the risk of CVD in offspring throughout their life.”

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

BMJ 2019; 367: l6398

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