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Maternal Diabetes Mellitus as a Risk Factor for High Blood Pressure in Late Childhood
Joana Oliveira Miranda1,2,3, Rui João Cerqueira4,2,3, Henrique Barros5,6
1From the Departamento de Cardiologia Pediátrica (J.O.M., J.C.A.), Centro Hospitalar São João, Porto, Portugal.
Insights
Maternal diabetes mellitus is linked to higher blood pressure (BP) in children by age 10. This association, particularly evident in males, is significantly influenced by the child's body mass index and other factors.
Area of Science:
- Cardiovascular Health
- Pediatric Health
- Endocrinology
Background:
- Intrauterine conditions can lead to lifelong cardiovascular issues.
- The long-term effects of maternal diabetes mellitus on offspring cardiovascular health are not fully understood.
- Understanding these impacts is crucial for early intervention and prevention strategies.
Purpose of the Study:
- To investigate the association between maternal diabetes mellitus and offspring blood pressure (BP) up to 10 years of age.
- To explore potential mediating factors in this association, such as body mass index, gestational age, birth type, and birth weight.
- To analyze the longitudinal changes in BP in offspring exposed to maternal diabetes mellitus in utero.
Main Methods:
- Utilized data from the prospective Generation XXI birth cohort (8301 mother-offspring pairs).
- Employed linear regression to model BP at ages 4, 7, and 10.
- Applied mixed-effects models for longitudinal BP variation and path analysis for mediation effects.
Main Results:
- Maternal diabetes mellitus was associated with significantly higher systolic and diastolic BP in offspring at age 10.
- The association was mediated by child's body mass index (73% indirect effect), gestational age, birth type, and birth weight.
- Longitudinal analysis revealed an accelerated increase in systolic BP in the maternal diabetes mellitus group, particularly in males.
Conclusions:
- Maternal diabetes mellitus is a significant risk factor for elevated offspring blood pressure in late childhood.
- Childhood body mass index plays a critical role in mediating the link between maternal diabetes and offspring hypertension.
- Findings suggest potential sex-specific prenatal programming mechanisms influencing cardiovascular health.
Abstract:
Intrauterine fetal conditions can have lifelong cardiovascular effects. The impact of maternal diabetes mellitus on children's cardiovascular profile is not well established. The goal of this study was to explore the association between maternal diabetes mellitus and offspring's blood pressure (BP) ≤10 years of age. Generation XXI is a prospective birth cohort, which enrolled 8301 mother-offspring pairs, including 586 (7.1%) children of diabetic mothers. The associations between maternal diabetes mellitus and BP at 4, 7, and 10 years of age was modeled using linear regression. A mixed-effects model was built to assess differences in BP variation over time. Path analysis was used to quantify effects of potential mediators. Maternal diabetes mellitus was associated with higher BP in offspring at the age of 10 (systolic: β, 1.48; 95% CI, 0.36-2.59; and diastolic: β, 0.86; 95% CI, 0.05-1.71). This association was independent of maternal perinatal characteristics, and it was mediated by child's body mass index and, to a lesser extent, by gestational age, type of birth, and birth weight (indirect effect proportion, 73%). No significant differences in BP were found at 4 and 7 years of age. Longitudinal analysis showed an accelerated systolic BP increase on maternal diabetes mellitus group (β, 1.16; 95% CI, 0.03-2.28). These finding were especially relevant in males, suggesting sex differences in the mechanisms of BP prenatal programing. Our results provide further evidence that maternal diabetes mellitus is associated with high BP late in childhood, demonstrating a significant role of child's body mass in the pathway of this association.
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