Laetitia Guillemette1, Brandy Wicklow1, Elizabeth A C Sellers1, Allison Dart1, Garry X Shen1, Vernon W Dolinsky1, Joseph W Gordon1, Davinder S Jassal1, Nathan Nickel1, Todd A Duhamel1, Dan Chateau1, Heather J Prior1, Jonathan McGavock2. 1. Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man. 2. Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man. jmcgavock@chrim.ca.
Abstract
BACKGROUND: It is unclear whether intrauterine exposure to maternal diabetes is associated with risk factors for cardiovascular disease and related end points in adulthood. We examined this potential association in a population-based birth cohort followed up to age 35 years. METHODS: We performed a cohort study of offspring born between 1979 and 2005 (n = 293 546) and followed until March 2015 in Manitoba, Canada, using registry-based administrative data. The primary exposures were intrauterine exposure to gestational diabetes and type 2 diabetes mellitus. The primary outcome was a composite measure of incident cardiovascular disease events, and the secondary outcome was a composite of risk factors for cardiovascular disease in offspring followed up to age 35 years. RESULTS: The cohort provided 3 628 576 person-years of data (mean age at latest follow-up 20.5 [standard deviation 6.4] years, 49.3% female); 2765 (0.9%) of the offspring experienced a cardiovascular disease end point, and 12 673 (4.3%) experienced a cardiovascular disease risk factor. After propensity score matching, the hazard for cardiovascular disease end points was elevated in offspring exposed to gestational diabetes (adjusted hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12-1.79) but not type 2 diabetes (adjusted HR 1.40, 95% CI 0.98-2.01). A similar association was observed for cardiovascular disease risk factors (gestational diabetes: adjusted HR 1.92, 95% CI 1.75-2.11; type 2 diabetes: adjusted HR 3.40, 95% CI 3.00-3.85). INTERPRETATION: Intrauterine exposure to maternal diabetes was associated with higher morbidity and risk related to cardiovascular disease among offspring up to 35 years of age.
BACKGROUND: It is unclear whether intrauterine exposure to maternal diabetes is associated with risk factors for cardiovascular disease and related end points in adulthood. We examined this potential association in a population-based birth cohort followed up to age 35 years. METHODS: We performed a cohort study of offspring born between 1979 and 2005 (n = 293 546) and followed until March 2015 in Manitoba, Canada, using registry-based administrative data. The primary exposures were intrauterine exposure to gestational diabetes and type 2 diabetes mellitus. The primary outcome was a composite measure of incident cardiovascular disease events, and the secondary outcome was a composite of risk factors for cardiovascular disease in offspring followed up to age 35 years. RESULTS: The cohort provided 3 628 576 person-years of data (mean age at latest follow-up 20.5 [standard deviation 6.4] years, 49.3% female); 2765 (0.9%) of the offspring experienced a cardiovascular disease end point, and 12 673 (4.3%) experienced a cardiovascular disease risk factor. After propensity score matching, the hazard for cardiovascular disease end points was elevated in offspring exposed to gestational diabetes (adjusted hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12-1.79) but not type 2 diabetes (adjusted HR 1.40, 95% CI 0.98-2.01). A similar association was observed for cardiovascular disease risk factors (gestational diabetes: adjusted HR 1.92, 95% CI 1.75-2.11; type 2 diabetes: adjusted HR 3.40, 95% CI 3.00-3.85). INTERPRETATION: Intrauterine exposure to maternal diabetes was associated with higher morbidity and risk related to cardiovascular disease among offspring up to 35 years of age.
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