The number of women diagnosed with diabetes before or during pregnancy has increased globally, and children of these women are more likely to have risk factors for future cardiovascular disease, such as high blood pressure and high blood sugar levels.
It was unclear, however, whether or to what extent exposure to diabetes in the womb increases the risk of developing cardiovascular disease in offspring over a lifetime.
An international team of researchers set out to evaluate associations between diabetes diagnosed before or during pregnancy and early onset cardiovascular disease in children during their first four decades of life.
They base their findings on national registry data for over 2.4 million children born without congenital heart disease in Denmark from 1977 to 2016.
Diabetes was categorized as pregestational or gestational and women with diabetic complications were identified.
Other potentially confounding factors, such as mother’s age, education, lifestyle and medical history were also considered.
During up to 40 years of follow-up, children of mothers with diabetes had a 29% increased overall rate of early onset cardiovascular disease compared with children of mothers who did not have diabetes.
The researchers also found higher rates for specific types of cardiovascular disease in children of mothers with diabetes, particularly heart failure, hypertensive disease, deep vein thrombosis, and pulmonary embolism.
Increased rates were seen in each age group before 20 years of age and from 20 to 40 years of age, regardless of the type of diabetes they were exposed to and rates were similar for both type 1 and type 2 diabetes.
Children of mothers with diabetic complications or with diabetes and a history of cardiovascular disease had the highest rates of early onset cardiovascular disease than children of mothers with diabetes only.
This is an observational study, so can’t establish cause and, despite adjusting for a wide range of variables, the authors cannot rule out the possibility that some of the results may have been due to unmeasured factors.
However, strengths of this study, recently published in the British Medical Journal, include the large sample size, long follow-up of up to 40 years, and findings that remained similar after further analyses, suggesting that they are robust.
The researchers highlight that if this association is shown to be causal, preventing, screening, and treating diabetes in women of childbearing age could be important not only for improving the health of the women but also for reducing long term risks of cardiovascular disease in their offspring.
And they call for future research to examine the degree of glycemic control during pregnancy that would minimize the risk of cardiovascular disease in offspring throughout their life.
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