Maternal Diabetes Increases Long-Term Cardiovascular Risk in Offspring, finds study
A recent nationwide cohort study found that diabetes during pregnancy is linked to a greater risk of CVD and its different types in the offspring, with higher risks noted after prenatal exposure to pre-pregnancy diabetes. The short-term effects of high blood sugar levels in mothers on the neonate, such as macrosomia and hypoglycemia, are established, but the long-lasting effects on the vasculature of the child have been unknown until recently. The study was published in JAMA Cardiology by Xingbo Mo and colleagues.
In order to elucidate the intricate association between diabetes in utero exposure and subsequent CVD health, investigators conducted a nationwide cohort study by linking Swedish national registers. Study participants included all individuals who were born in the nation between January 1, 1973, and December 31, 2014, having an extended follow-up period until December 31, 2023. Diabetic exposures among mothers were classified as either gestational diabetes and pregestational diabetes (including types 1 and 2).
The primary outcomes considered for this analysis included incidence of overall CVD and several other CVD subtypes based on carefully identified records of national inpatient and outpatient registries. HRs and 95% CI values were calculated using the Cox proportional hazards regression analysis model. Furthermore, sibling analyses were carried out in order to account for potential confounders including unknown shared familial or genetic factors. Mediation analysis was performed to quantify the impact of adverse perinatal outcomes such as CHD, preterm birth, and LGA.
Key findings:
- In the final analysis of the cohorts, there were 4,274,414 participants, where 51.39% were males and the mean age was 27.4 years at the end of the follow-up period.
- Within the enormous population analyzed, 61,336 people (1.46%) were exposed to maternal diabetes before birth, whereas 4,213,078 (98.56%) were not.
- During the median follow-up of 27.6 years, 7.36% of the total population was found to have definite cardiovascular disease diagnosis.
- The presence of any maternal diabetes increased the overall risk of CVD (HR, 1.16; 95% CI, 1.12-1.20).
- The risk was higher among those whose mothers had pregestational diabetes (HR, 1.29; 95% CI, 1.21-1.38) than among those whose mothers had gestational diabetes (HR, 1.11; 95% CI, 1.05-1.17).
- The offspring exposed to maternal diabetes showed higher risks of heart failure (HR, 1.65; 95% CI, 1.37-2.00), cerebrovascular diseases (HR, 1.31; 95% CI, 1.12-1.52), atrial fibrillation (HR, 1.27; 995% CI, 1.05-1.54), and venous thromboembolism (HR, 1.20; 95% CI, 1.07-1.34).
- Comprehensive mediation analyses revealed that congenital heart disease directly or indirectly mediated 31.87% of the association, followed by preterm birth at 16.06%, and large for gestational age (LGA) status at 14.18%.
The present comprehensive cohort study highlights the fact that maternal diabetes in pregnancy is a risk factor for the development of increased risk of CVD, including several types of cardiovascular disease, in the offspring. The importance of these results in the field of preventive cardiology and maternal-fetal medicine cannot be overstated, as the clinical management of maternal diabetes in pregnancy has critical consequences for the well-being of the offspring for decades to come.
Reference:
Mo X, Janszky I, Wang H, et al. Maternal Diabetes and Risk of Early-Onset Cardiovascular Diseases in Offspring. JAMA Cardiol. Published online May 13, 2026. doi:10.1001/jamacardio.2026.0915
