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Multisystem Morbidity and Mortality in Offspring of Women With Type 1 Diabetes (the EPICOM Study): A Register-Based
Sine Knorr1, Kirstine Stochholm2, Zuzana Vlachová3
1Department of Endocrinology and Internal Medicine and Department of Molecular Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Insights
Children born to mothers with type 1 diabetes face higher long-term risks of mortality and hospital admissions. Maternal glycemic control (HbA1c) during pregnancy is linked to increased hospitalizations in offspring.
Area of Science:
- Endocrinology
- Pediatrics
- Public Health
Background:
- Pregestational type 1 diabetes in mothers poses potential health risks to offspring.
- Long-term outcomes for these children require comprehensive investigation.
Purpose of the Study:
- To assess the long-term effects of maternal pregestational type 1 diabetes on offspring mortality, hospital admissions, and medication use.
- To investigate the association between maternal HbA1c levels and offspring health outcomes.
Main Methods:
- Prospective cohort study combining clinical and register data.
- Comparison of offspring (n=1,326) of mothers with type 1 diabetes to matched controls (n=131,884).
- Follow-up from birth to 13-21 years, analyzing mortality, hospital admissions, and medication use.
Main Results:
- Significantly increased overall mortality in offspring of mothers with type 1 diabetes (HR 2.10).
- Elevated hospital admission rates in offspring (IRR 1.45), associated with maternal HbA1c levels.
- Increased overall medication use in offspring (IRR 1.13).
Conclusions:
- Maternal type 1 diabetes has lasting adverse impacts on offspring health, including higher mortality and morbidity.
- Improved glycemic control during pregnancy is crucial for reducing offspring hospitalizations.
Objective:
This study examined the long-term consequences for offspring born to mothers with pregestational type 1 diabetes regarding mortality, hospital admissions, and medication. We also examined the association between HbA1c levels during pregnancy and mortality and incidence of hospital admissions.
Research Design And Methods:
We performed a prospective combined clinical and register-based cohort study comparing mortality, hospital admissions, and use of medication in offspring (n = 1,326) of women with pregestational type 1 diabetes (index children) with matched control subjects (n = 131,884). We also examined the association between HbA1c levels during pregnancy and mortality and the incidence of hospital admissions. Participants were monitored from birth to the age of 13-21 years.
Results:
Overall mortality was significantly increased for index children (hazard ratio 2.10, 95% CI 1.33-3.30, P = 0.001). The incidence of hospital admissions for index children was significantly increased (incidence rate ratio [IRR] 1.45, 95% CI 1.38-1.53, P < 0.001), and this was the case for all age groups until the age of 15 years. The incidence of hospital admissions among index children was positively associated with maternal HbA1c before pregnancy and in the first trimester. In addition, the overall use of medication was increased in index children (IRR 1.13, 95% CI 1.07-1.19, P < 0.001).
Conclusions:
Type 1 diabetes during pregnancy has long-term implications on the health of offspring, with increased mortality, incidence of hospital admissions, and use of medication. Among mothers with type 1 diabetes, glycemic regulation is positively associated with incidence of hospital admissions in offspring.
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