Children of Diabetic Mothers at Greater Risk of Early Onset Heart Disease

Yongfu Yu, PhD

Children born to mothers with diabetes could be at an increased risk of developing cardiovascular disease before the age of 40 based on the results of a new study from Europe.

Results of the study, which examined more than 2.4 million liveborn children, found offspring of mothers with diabetes were 29% more likely to develop early onset cardiovascular disease compared to children born to mothers without diabetes—calling for greater attention to this potential association among physicians to prevent cardiovascular disease in the future.

To further detail potential associations between maternal diabetes and early onset cardiovascular disease in offspring, investigators designed an observational cohort study using national registry data of children born without congenital heart disease in Denmark from 1977 to 2016. For the purpose of the analysis, investigators followed patients from birth until the first diagnosis of cardiovascular disease, death, emigration, or December 31, 2016—whichever occurred first.

Investigators defined maternal diabetes as gestational diabetes or pregestational diabetes, which investigators classified as a diagnosis of type 1 or type 2 diabetes before childbirth. Diabetes information was obtained through the Danish National Diabetes Register, the Danish National Patient Registry, and the Danish National Prescription Registry.

The primary outcome of the study was early onset cardiovascular disease in the children examined. Investigators noted the inclusion of multiple forms of cardiovascular disease in their analyses, including ischemic heart disease, cerebrovascular disease, stroke, heart failure, atrial fibrillation, hypertensive disease, deep vein thrombosis, and pulmonary embolism.

Of the 2,432,000 children included in the study, 2.3% (54,864) were exposed to maternal pregestational diabetes or gestational diabetes. In regard to diabetes classification, 1.1% (26,272) of offspring were born to mothers with gestational diabetes, while 0.9% (22,095) had type 1 and 0.3% had type 2. When comparing mothers, investigators found mothers with diabetes were more likely to be older, have had higher education, live alone, and smoke less during pregnancy. Children of mothers with diabetes had higher rates of developing diabetes, obesity, hypertension, hypercholesterolemia, and chronic kidney diseases.

Analyses revealed children born to mothers with diabetes had a 29% increased overall rate of early onset cardiovascular disease compared to those born to mothers without diabetes (HR: 1.29, 95% CI: 1.21 to 1.37). When assessing by type of diabetes, investigators found both pregestational diabetes (1.34 (1.25 to 1.43)) and gestational diabetes (1.19 (1.07 to 1.32)) were associated with increased rates of cardiovascular disease.

Additionally, increased rates were seen among specific cardiovascular diseases including heart failure (1.45 (0.89 to 2.35)), hypertensive disease (1.78 (1.50 to 2.11)), deep vein thrombosis (1.82 (1.38 to 2.41)), and pulmonary embolism (1.91 (1.31 to 2.80)). Investigators also pointed out a higher incidence was observed in the offspring of mothers with diabetic complications (1.60 (1.25 to 2.05)).

“Our study provides evidence that children of mothers with diabetes, especially those with a history of CVD or with diabetic complications, had increased rates of early onset CVD throughout the early decades of life. These findings highlight the importance of effective strategies for screening and preventing diabetes in women of childbearing age," investigators wrote.

This study, titled “Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up,” is published online in The BMJ.