TOPLINE:

Individuals whose mothers had diabetes during pregnancy had an increased long-term risk for cardiovascular disease (CVD), especially when diabetes was present before pregnancy. Part of this association was explained by congenital heart defects, preterm birth, and large size at birth in offspring.

METHODOLOGY:

• Researchers conducted a population-based cohort study to examine the association between maternal diabetes during pregnancy and later risk for CVD in offspring and related factors.
• They used linked Swedish registers and included over 4.2 million singleton births between January 1973 and December 2014; the mean age at the end of follow-up was 27.4 years, and 51.39% were men.
• Offspring were categorized based on whether their mothers had diabetes during pregnancy. Maternal diabetes included any diabetes, gestational diabetes, or pregestational diabetes, with type 1 and type 2 separated when available.
• The primary outcome was the incidence of overall CVD and specific CVD subtypes in offspring. Offspring were followed from birth until a CV event, death, emigration, or December 2023, yielding a median follow-up of 27.6 years.
• Researchers compared siblings to account for shared family factors. They also conducted mediation analyses to assess whether adverse birth outcomes or early-life conditions explained part of the association.

TAKEAWAY:

• Overall, 1.46% of offspring were born to mothers with diabetes during pregnancy. Any maternal diabetes was associated with a 16% increased risk for overall CVD in offspring (adjusted hazard ratio [aHR], 1.16; 95% CI, 1.12-1.20), with a higher risk with pregestational diabetes (aHR, 1.29; 95% CI, 1.21-1.38) than with gestational diabetes (aHR, 1.11; 95% CI, 1.05-1.17).
• In a model adjusted for offspring age, maternal diabetes was associated with elevated risks for vascular diseases (HR, 1.60; 95% CI, 1.51-1.70), structural heart diseases (HR, 2.00; 95% CI, 1.82-2.20), and arrhythmias (HR, 1.32; 95% CI, 1.23-1.41).
• The association between any maternal diabetes and the risk for CVD in offspring persisted in sibling comparisons.
• Congenital heart disease, offspring diabetes, preterm birth, and large for gestational age explained 31.9%, 16.3%, 16.1%, and 14.2% of the overall association, respectively.

IN PRACTICE:

“These novel findings may reflect differences in outcome ascertainment and follow-up duration and underscore the broader cardiovascular consequences of in utero exposure to maternal diabetes,” the study researchers wrote.

SOURCE:

Thia study was led by Xingbo Mo, PhD, of Karolinska Institutet in Stockholm, Sweden. It was published online on May 13 in JAMA Cardiology.

LIMITATIONS:

Maternal diabetes came from registry records and may have been misclassified. Some milder cases of CVD may also have been missed. Data on BMI and smoking were not available for the entire cohort.

DISCLOSURES:

This study received support from grants from the Swedish Heart and Lung Foundation, the Karolinska Institutet Research Foundation, and the Swedish Research Council for Health, Working Life and Welfare. The authors did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.