Maternal diabetes in pregnancy linked to increased long-term risk of CVD in offspring

Children born to mothers with diabetes during pregnancy have an elevated long-term risk of cardiovascular disease (CVD), as suggested in a population-based cohort study.

Researchers used linked national registers and identified 4,274,414 individuals (mean age at the end of follow-up 27.4 years, 51.39 percent male), of whom 61,336 (1.46 percent) were exposed to maternal diabetes and 4,213,078 (98.56 percent) were not exposed.

Outcomes of interest were incident overall CVD and specific CVD subtypes in the offspring. Sibling analyses were also performed to account for shared familial factors. Mediation analyses evaluated the contribution of congenital heart disease (CHD), preterm birth, and large for gestational age (LGA).

Over a median follow-up of 27.6 years, CVD occurred in 7.36 percent of participants. Maternal diabetes during pregnancy was associated with a 16-percent increased risk of overall CVD in the offspring (hazard ratio [HR], 1.16, 95 percent confidence interval [CI], 1.12–1.20). The risk increase was greater for pregestational diabetes (HR, 1.29, 95 percent CI, 1.21–1.38) than for gestational diabetes (HR, 1.11, 95 percent CI, 1.05–1.17).

Results were consistent in sibling analyses.

The elevated risk of CVD associated with exposure to maternal diabetes was pronounced for some CVD subtypes, including venous thromboembolism (HR, 1.20, 95 percent CI, 1.07–1.34), cerebrovascular diseases (HR, 1.31, 95 percent CI, 1.12–1.52), atrial fibrillation (HR, 1.27, 95 percent CI, 1.05–1.54), and heart failure (HR, 1.65, 95 percent CI, 1.37–2.00).

In mediation analyses, CHD, preterm birth, and LGA directly and/or indirectly mediated 31.87 percent, 16.06 percent, and 14.18 percent of the association between any maternal diabetes and offspring CVD risk, respectively.