Maternal Diabetes and Risk of Early-Onset Cardiovascular Diseases in Offspring

Area of Science:

• Cardiovascular Science
• Reproductive Health
• Pediatric Health

Background:

• Long-term cardiovascular disease (CVD) risks in offspring exposed to maternal diabetes in utero are not well understood.
• Mechanisms linking maternal diabetes to offspring CVD remain unclear.

Purpose of the Study:

• To investigate the association between maternal diabetes during pregnancy and offspring risks of overall CVD and specific CVD subtypes.
• To determine if adverse perinatal and early-life outcomes mediate these associations.

Main Methods:

• Nationwide population-based cohort study in Sweden (1973-2023) using linked national registers.
• Included over 4.2 million individuals, analyzing associations between maternal diabetes (gestational, type 1, type 2) and offspring CVD.
• Utilized Cox regression, sibling analyses, and mediation analyses for congenital heart disease, preterm birth, and large for gestational age.

Main Results:

• Maternal diabetes was linked to increased overall CVD risk in offspring (HR 1.16).
• Pregestational diabetes showed a higher risk (HR 1.29) than gestational diabetes (HR 1.11).
• Specific CVD subtypes, including venous thromboembolism, cerebrovascular diseases, atrial fibrillation, and heart failure, were elevated in offspring exposed to maternal diabetes.

Conclusions:

• Maternal diabetes during pregnancy is associated with increased long-term CVD risks in offspring.
• Congenital heart disease, preterm birth, and large for gestational age partially mediate the association between maternal diabetes and offspring CVD risk.
• Findings emphasize the importance of perinatal and early-life factors in offspring CVD risk, particularly for mothers with diabetes.