Diabetes During Pregnancy Could Raise Lifelong Heart Risks for Children

MONDAY, Sept. 28, 2020 — The foundation for early heart disease might begin not during childhood or in the years that follow, but in the womb.

Researchers studying nearly 30 years of data from families in Manitoba, Canada, found a strong connection between heart disease risk factors in teens and young adults and their mother’s type 2 or gestational diabetes.

“I was surprised at the strength of the association, because we see a twofold, threefold higher risk for those who are exposed to diabetes compared to those who are not exposed,” said study author Laetitia Guillemette. She was a doctoral degree candidate at the University of Manitoba during the study, and is now a scientific evaluator for Health Canada.

For the study, the researchers used data from nearly all children born in Manitoba over three decades to analyze the impact on offspring who were between the ages of 10 and 35 when the study concluded.

The data showed the health history of more than 290,000 children born to 190,000 mothers between 1979 and 2005. The investigators found that 2.8% of those children had intrauterine exposure to gestational diabetes and 1.1% to pre-existing type 2 diabetes.

The findings showed that more than 8,700 of the offspring were diagnosed with high blood pressure, almost 3,600 had type 2 diabetes and 715 had ischemic heart disease. Children of mothers who had diabetes were 30% to 80% more likely to develop a heart condition, and two to three times more likely to develop a risk factor for heart disease, such as high blood pressure or diabetes.

These health issues were also discovered at earlier ages than their peers whose mothers did not have diabetes while pregnant. Previous studies had found an increased risk of developing type 2 diabetes for those with intrauterine exposure to diabetes, but not heart disease.

Dr. Robert Gabbay is chief science and medical officer for the American Diabetes Association. He said, “This is looking at individuals that are relatively young for heart disease. That is really concerning. By age 35, it could lead to heart disease. We typically think of heart disease being at a much older age.”

During pregnancy, controlling diabetes is especially important and can be done through diet, medication as needed, and working with the patient’s health care team to figure out what’s best, Gabbay added.

“We know that people at higher blood sugars during pregnancy have larger babies, have more likelihood of challenges during delivery, higher cesarean rate, a variety of pregnancy complications,” Gabbay said. “Whereas higher blood sugar leads to all of those things, controlling blood sugars prevents all those things, so the link is really strong.”

The study, published Sept. 28 in the CMAJ (Canadian Medical Association Journal), doesn’t determine why maternal diabetes affects the heart. But one hypothesis suggests that it’s because the fetuses’ organs are made in real time while using the nutrients available to them, Guillemette said.

“The baby is basically setting up for a life of being exposed to those kinds of nutrients and then becomes exposed to different kinds of nutrients when it’s a growing person. There might be a disjointed message between how the body is set up and what it receives to function,” Guillemette said.

Another hypothesis is that if the nutrients aren’t well-balanced during growth, the organs are setting up in an imperfect way from birth and not working as well as they could be, she added.

“My goal was to highlight the fact that many of the things that affect our health are not directly related to individual decisions and lifestyles,” Guillemette said.

The study authors suggested that the findings could be useful for preventive health, including screening children who have had intrauterine exposure to diabetes for cardiovascular risk factors. Guillemette also hopes policy makers can work on creating a healthier environment for everyone.

“Even though we adjusted for it in our study, we do see that diabetes and heart disease are both clustering with poverty. If we tackled poverty, maybe we would erase two problems,” Guillemette said. “I think the takeaway from this is also that we can’t look at just interventions that target diabetes and just interventions that target heart disease because they’re all related, and they’re all related to other things.”

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