Maternal diabetes during pregnancy may have long-term cardiovascular implications for offspring beyond the perinatal period. A nationwide population-based cohort study evaluated whether prenatal exposure to maternal diabetes was associated with incident cardiovascular disease (CVD) and specific cardiovascular subtypes in offspring later in life.

The study included 4,274,414 individuals born in Sweden between 1973 and 2014, with follow-up through 2023. Among them, 61,336 individuals had prenatal exposure to maternal diabetes, including gestational diabetes and pregestational type 1 or type 2 diabetes. Median follow-up duration was 27.6 years, and the primary outcome was incident CVD identified through national inpatient and outpatient registers.

Findings

• During a median follow-up of 27.6 years, 7.36% of participants developed CVD.
• Any maternal diabetes exposure was associated with higher overall offspring CVD risk (HR 1.16; 95% CI 1.12-1.20).
• Associations were stronger for pregestational diabetes (HR 1.29; 95% CI 1.21-1.38) than gestational diabetes (HR 1.11; 95% CI 1.05-1.17).
• Increased risks were observed for several CVD subtypes, including heart failure (HR 1.65; 95% CI 1.37-2.00), cerebrovascular disease (HR 1.31; 95% CI 1.12-1.52), atrial fibrillation (HR 1.27; 95% CI 1.05-1.54), and venous thromboembolism (HR 1.20; 95% CI 1.07-1.34).
• Mediation analyses showed that congenital heart disease (CHD), preterm birth, and large-for-gestational-age (LGA) status mediated 31.87%, 16.06%, and 14.18% of the association, respectively.

The findings suggest that prenatal exposure to maternal diabetes may contribute to elevated long-term cardiovascular risk in offspring, particularly following pregestational diabetes.