Children of mothers with diabetes have increased rates of early onset cardiovascular disease (CVD) from childhood up to the age of 40 and the increased rates are more pronounced among children of mothers with a history of CVD or diabetic complications.

The study published in the BMJ evaluated associations between diabetes diagnosed before or during pregnancy and early onset CVD in children during their first four decades of life. It is based on national registry data for over 2.4 million children born without congenital heart disease in Denmark from 1977 to 2016.

Diabetes was categorised as pregestational (before pregnancy) or gestational (during pregnancy) and women with diabetic complications were identified. Other potentially influential factors, such as mother’s age, education, lifestyle and medical history were also taken into account.

Prevention of diabetes in women of childbearing age

During up to 40 years of follow-up, children of mothers with diabetes had a 29% increased overall rate of early onset CVD compared with children of mothers who did not have diabetes (cumulative risks: 17.8% vs 13.1% ). The researchers also found higher rates for specific types of CVD in children of mothers with diabetes, particularly heart failure (45%), hypertensive disease (78%), deep vein thrombosis (82%), and pulmonary embolism (91%).

Increased rates were seen in each age group in childhood (before 20 years of age) and early adulthood (from 20 to 40 years of age), regardless of the type of diabetes they were exposed to (pregestational or gestational) and rates were similar for both type 1 and type 2 diabetes.

Children of mothers with diabetic complications or with diabetes and a history of CVD had the highest rates of early onset CVD than children of mothers with diabetes only.

This is an observational study, so can’t establish cause and, despite adjusting for a wide range of variables, the authors cannot rule out the possibility that some of the results may have been due to unmeasured factors. However, strengths include the large sample size, long follow-up of up to 40 years, and findings that remained similar after further analyses, suggesting that they are robust.

The findings “highlight the importance of effective strategies for screening and preventing diabetes in women of childbearing age,” said the researchers. They call for future research to examine the degree of blood sugar (glycaemic) control during pregnancy that would minimise the risk of CVD in offspring throughout their life.