Maternal diabetes during pregnancy has been associated with adverse perinatal outcomes, but its relationship with long-term cardiovascular disease (CVD) risk in offspring has not been fully defined. A nationwide population-based cohort study from Sweden published in JAMA Cardiology evaluated whether in utero exposure to maternal diabetes is associated with increased long-term cardiovascular risk in offspring.
The study included individuals born in Sweden between 1973 and 2014 with follow-up through December 2023 using linked national health registers. Incident cardiovascular disease diagnoses were identified through inpatient and outpatient registries, while sibling analyses were performed to account for shared familial factors. Mediation analyses evaluated the contributions of congenital heart disease (CHD), preterm birth, and large-for-gestational-age (LGA) status.
Findings
- The cohort included 4,274,414 individuals, of whom 61,336 (1.46%) were exposed to maternal diabetes during pregnancy.
- Over a median follow-up of 27.6 years, 7.36% of participants developed cardiovascular disease.
- Offspring exposed to maternal diabetes had higher risk of incident cardiovascular disease compared with unexposed offspring (HR 1.16; 95% CI, 1.12-1.20).
- Risk was greater following pregestational diabetes (HR 1.29; 95% CI, 1.21-1.38) than gestational diabetes (HR 1.11; 95% CI, 1.05-1.17).
- Prenatal exposure to maternal diabetes was associated with higher risks of venous thromboembolism (HR 1.20; 95% CI, 1.07-1.34), cerebrovascular disease (HR 1.31; 95% CI, 1.12-1.52), atrial fibrillation (HR 1.27; 95% CI, 1.05-1.54), and heart failure (HR 1.65; 95% CI, 1.37-2.00).
- Congenital heart disease, preterm birth, and large-for-gestational-age status accounted for part of the observed association between maternal diabetes exposure and offspring cardiovascular risk.
In this nationwide cohort study, maternal diabetes during pregnancy was associated with increased long-term cardiovascular risk in offspring, particularly following pregestational diabetes.
