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Link between diabetes in mothers and heart disease in children

Children of mothers with diabetes had 29% higher rate of early onset CVD

Adrian O'Dowd

Thursday, 05 December 2019

Children of mothers with diabetes appear to have higher rates of early onset cardiovascular disease (CVD) from childhood up to the age of 40, suggest a study* from Denmark published today by The BMJ.

Increased rates were also more pronounced among children of mothers with a history of CVD or diabetic complications, the study also found, leading to a recommendation that preventing, screening, and treating diabetes in women of childbearing age could be important for improving the health of the women but also in reducing long-term risks of CVD in their children.

Numbers 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 CVD, such as high blood pressure and high blood sugar levels.

However, it is unclear whether or to what extent exposure to diabetes in the womb increases the risk of developing CVD in offspring over a lifetime.

An international team of researchers, therefore, set out to evaluate associations between diabetes diagnosed before or during pregnancy and early onset CVD in children during their first four decades of life.

They based their findings on national registry data for more than 2.4 million children born without congenital heart disease in Denmark from 1977 to 2016.

Potentially influential factors, such as the mother’s age, education, lifestyle and medical history were taken into account.

Results showed that during up to 40 years of follow-up, children of mothers with diabetes had a 29% increased overall rate of early onset CVD compared with children of mothers who did not have diabetes.

The researchers also found higher rates for specific types of CVD children of mothers with diabetes, particularly heart failure (45%), hypertensive disease (78%), deep vein thrombosis (82%), and pulmonary embolism (91%).

Increased rates were seen in each age group in childhood (before 20 years of age) and early adulthood (from 20 to 40 years of age), regardless of the type of diabetes they were exposed to (pregestational or gestational) and rates were similar for both type 1 and type 2 diabetes.

This was an observational study, so it cannot establish cause and the authors acknowledged that they could not rule out the possibility that some of the results may have been due to unmeasured factors.

Nevertheless, the study had a large sample size, long follow-up of up to 40 years, and findings that remained similar after further analyses.

They concluded: “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.”

They called for future research to examine the degree of blood sugar control during pregnancy that would minimise the risk of CVD in offspring throughout their life.

*Yu Y, Arah O A, Liew Z, et al. Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up. BMJ 2019;367:l6398. DOI:10.1136/bmj.l6398

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