In utero exposure to gestational diabetes mellitus and cardiovascular risk factors in youth: A longitudinal analysis in the EPOCH cohort

Abstract

Objective: To examine associations of maternal gestational diabetes mellitus (GDM) with offspring cardiovascular biomarkers from late childhood through adolescence.

Methods: We used mixed effects linear regression models to examine associations of maternal GDM (n = 92 cases of 597) with average offspring levels of serum lipids (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides) and systolic blood pressure (SBP) across two research visits spanning approximately 10.6 and 16.9 years of age. In sex-stratified analysis, we evaluated the impact of adjustment for sociodemographic characteristics, pubertal status, physical activity and total energy intake, maternal body mass index (BMI), GDM treatment, and child's BMI.

Results: After adjusting for child's age, pubertal status, race/ethnicity, and maternal education and smoking, GDM exposure was associated with higher total (0.38 [95% CI, 0.16-0.61] mmol/L) and LDL cholesterol (0.34 [95% CI, 0.14-0.53] mmol/L) in girls. These estimates were robust to adjustment for lifestyle characteristics and maternal BMI but were attenuated after accounting for GDM treatment with no appreciable change following further adjustment for current BMI. In boys, maternal GDM corresponded with 4.50 (1.90-7.10) mmHg higher SBP. This association persisted after accounting for sociodemographic/lifestyle characteristics, maternal BMI, and GDM treatment but was attenuated after adjusting for current BMI.

Conclusions: Maternal GDM is related to offspring lipid profile and SBP in a sex-specific manner.

Keywords: adolescence; blood pressure; gestational diabetes mellitus; longitudinal; low-density lipoprotein; total cholesterol.

FIGURE 1

Mean ± SE for lipid profile components among GDM-exposed vs unexposed EPOCH participants. Estimates are adjusted for child’s age (years), pubertal status (pre vs post-pubertal), race/ethnicity (non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic other), maternal smoking habits during pregnancy (yes vs no), and education level at time of birth (<high school, high school, and >high school). *Statistically significant difference at α = .05. EPOCH, Exploring Perinatal Outcomes in Children; GDM, gestational diabetes mellitus; HDL, high-density lipoprotein; LDL, low-density lipoprotein

FIGURE 2

Mean ± SE for SBP among GDM-exposed vs unexposed EPOCH participants. Estimates are adjusted for child’s age (years), pubertal status (pre vs post-pubertal), race/ethnicity (non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic other), maternal smoking habits during pregnancy (yes vs no) and education level at time of birth (<high school, high school, and >high school). *Statistically significant difference at α = .05. EPOCH, Exploring Perinatal Outcomes in Children; GDM, gestational diabetes mellitus; HDL, high-density lipoprotein; LDL, low-density lipoprotein; SBP, systolic blood pressure