Exposure to Diabetes in the Womb Could Increase Heart Disease Risk

Jonathan McGavock, PhD

New research from the University of Manitoba suggests exposure to diabetes in the womb could put offspring at a greater risk of developing heart disease as young adults and teenagers.

An analysis of more than 290,000 children born from 1979-2005, results of the study suggest exposure to both gestational diabetes and preexisting type 2 diabetes was associated with an increased risk of cardiovascular disease, including hypertension, type 2 diabetes, and ischemic heart disease, before the age of 35 years.

"Using data for nearly all children born in Manitoba over a period of 30 years, we found that children born to mothers with diabetes in pregnancy were 30%-80% more likely to develop a heart condition and 2.0 to 3.4 times more likely to develop a heart disease risk factor than children born to mothers without diabetes in pregnancy," said Jonathan McGavock, PhD, associate professor of Pediatrics and Child Health at the University of Manitoba, in a statement.

To learn more about the effects of intrauterine exposure to maternal diabetes, investigators designed the current study with the aim of assessing potential associations in a population-based cohort. For the purpose of the analysis, investigators selected the Manitoba Population Research Data Repository, which contained information related to 293,546 offspring born between 1979-2005 followed through March 2015.

The primary outcome of the study was a composite measure of the first incident cardiovascular disease event occurring in offspring without a viral, familial, or alcoholic origin between 10 years of age and end of the study period. First incident cardiovascular disease events included diagnoses of cardiac arrest, myocardial infarction, ischemic heart disease and cerebral infarction. Investigators pointed out 10 years was chosen as the cut-off in order to distinguish between inherited or autoimmune cardiovascular disease-related risk factors.

The secondary outcome of the study was a composite measure of the first incident cardiovascular disease risk factor among offspring, which included hypertension, dyslipidemia, and type 2 diabetes. In the event an offspring had multiple outcomes, investigators only considered the first diagnosis.

Of the 293,546 offspring, investigators obtained 3,628,576 person-years of data. The cohort had a mean age at latest follow-up of 20.5 years and 49.3% were female. In total, 2.8% of children included in the study were exposed to gestational diabetes and 1.1% were exposed to preexisting type 2 diabetes. During the follow-up period, 2765 experienced a cardiovascular disease end point and 12,673 experienced a cardiovascular disease risk factor. Of the 12,673 who experienced a risk factor, the most common diagnoses were hypertension (8713 people), type 2 diabetes (3568 people) and ischemic heart disease (715).

After propensity score matching, investigators found those exposed to gestational diabetes (aHR, 1.42; 95% CI, 1.12-1.79) but not those exposed to type 2 diabetes (aHR, 1.40; 95% CI, 0.98-2.01) had an increased risk for a cardiovascular disease end point. Additionally, investigators noted a similar association was observed for cardiovascular disease risk factors (gestational diabetes: aHR, 1.92; 95% CI, 1.75-2.11; type 2 diabetes: aHR, 3.40; 95% CI, 3.00-3.85).

"These observations support our hypothesis that cardiovascular disease morbidity in adolescence and early adulthood is related to exposure to maternal diabetes in utero," noted McGavock, in the aforementioned statement.

This study, “Intrauterine exposure to diabetes and risk of cardiovascular disease in adolescence and early adulthood: a population-based birth cohort study,” was published in the Canadian Medical Association Journal.