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Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up

BMJ (Online), 2019-12, Vol.367, p.l6398-l6398 [Peer Reviewed Journal]

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2019 BMJ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019 BMJ ;ISSN: 1756-1833 ;ISSN: 0959-8138 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.l6398 ;PMID: 31801789

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Title:
Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up
Author: Yu, Yongfu ; Arah, Onyebuchi A ; Liew, Zeyan ; Cnattingius, Sven ; Olsen, Jørn ; Sørensen, Henrik Toft ; Qin, Guoyou ; Li, Jiong
Subjects: Adult ; Age ; Births ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Childbirth & labor ; Children ; Congenital diseases ; Coronary artery disease ; Denmark - epidemiology ; Diabetes ; Diabetes mellitus (insulin dependent) ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus - physiopathology ; Diabetes, Gestational - physiopathology ; Diagnosis ; Embolism ; Emigration ; Endokrinologi och diabetes ; Families & family life ; Female ; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ; Follow-Up Studies ; Health risk assessment ; Heart ; Heart diseases ; Humans ; Hälsovetenskap ; Kardiologi ; Klinisk medicin ; Male ; Maternal Exposure - adverse effects ; Medicin och hälsovetenskap ; Mortality ; Mothers ; Population ; Population studies ; Pregnancy ; Pregnancy complications ; Prenatal Exposure Delayed Effects - epidemiology ; Prenatal Exposure Delayed Effects - etiology ; Progeny ; Thrombosis ; Young Adult ; Young adults
Is Part Of: BMJ (Online), 2019-12, Vol.367, p.l6398-l6398
Description: AbstractObjectiveTo evaluate the associations between maternal diabetes diagnosed before or during pregnancy and early onset cardiovascular disease (CVD) in offspring during their first four decades of life.DesignPopulation based cohort study.SettingDanish national health registries.ParticipantsAll 2 432 000 liveborn children without congenital heart disease in Denmark during 1977-2016. Follow-up began at birth and continued until first time diagnosis of CVD, death, emigration, or 31 December 2016, whichever came first.Exposures for observational studiesPregestational diabetes, including type 1 diabetes (n=22 055) and type 2 diabetes (n=6537), and gestational diabetes (n=26 272).Main outcome measuresThe primary outcome was early onset CVD (excluding congenital heart diseases) defined by hospital diagnosis. Associations between maternal diabetes and risks of early onset CVD in offspring were studied. Cox regression was used to assess whether a maternal history of CVD or maternal diabetic complications affected these associations. Adjustments were made for calendar year, sex, singleton status, maternal factors (parity, age, smoking, education, cohabitation, residence at childbirth, history of CVD before childbirth), and paternal history of CVD before childbirth. The cumulative incidence was averaged across all individuals, and factors were adjusted while treating deaths from causes other than CVD as competing events.ResultsDuring up to 40 years of follow-up, 1153 offspring of mothers with diabetes and 91 311 offspring of mothers who did not have diabetes were diagnosed with CVD. Offspring of mothers with diabetes had a 29% increased overall rate of early onset CVD (hazard ratio 1.29 (95% confidence interval 1.21 to 1.37); cumulative incidence among offspring unexposed to maternal diabetes at 40 years of age 13.07% (12.92% to 13.21%), difference in cumulative incidence between exposed and unexposed offspring 4.72% (2.37% to 7.06%)). The sibship design yielded results similar to those of the unpaired design based on the whole cohort. 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 CVD in offspring. We also observed varied increased rates of specific early onset CVDs, particularly 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)). Increased rates of CVD were seen in different age groups from childhood to early adulthood until age 40 years. The increased rates were more pronounced among offspring of mothers with diabetic complications (1.60 (1.25 to 2.05)). A higher incidence of early onset CVD in offspring of mothers with diabetes and comorbid CVD (1.73 (1.36 to 2.20)) was associated with the added influence of comorbid CVD but not due to the interaction between diabetes and CVD on the multiplicative scale (P value for interaction 0.94).ConclusionsChildren of mothers with diabetes, especially those mothers with a history of CVD or diabetic complications, have increased rates of early onset CVD from childhood to early adulthood. If maternal diabetes does have a causal association with increased CVD rate in offspring, the prevention, screening, and treatment of diabetes in women of childbearing age could help to reduce the risk of CVD in the next generation.
Publisher: England: BMJ Publishing Group LTD
Language: English
Identifier: ISSN: 1756-1833
ISSN: 0959-8138
EISSN: 1756-1833
DOI: 10.1136/bmj.l6398
PMID: 31801789
Source: BMJ Open Access Journals
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Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up

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