Gestational diabetes mellitus and offspring's carotid intima-media thickness at birth: MySweetHeart Cohort study

Abstract

Objective: Hyperglycaemia during pregnancy is associated with cardiometabolic risks for the mother and the offspring. Mothers with gestational diabetes mellitus (GDM) have signs of subclinical atherosclerosis, including increased carotid intima-media thickness (CIMT). We assessed whether GDM is associated with increased CIMT in the offspring at birth.

Design and setting: MySweetHeart Cohort is a prospective cohort study conducted in Switzerland.

Participants, exposure and outcome measures: This work included pregnant women with and without GDM at 24-32 weeks of gestation and their singleton live-born offspring with data on the primary outcome of CIMT. GDM was diagnosed based on the criteria of the International Association of Diabetes and Pregnancy Study Groups. Offspring's CIMT was measured by ultrasonography after birth (range 1-19 days).

Results: Data on CIMT were available for 99 offspring of women without GDM and 101 offspring of women with GDM. Maternal age ranged from 18 to 47 years. Some 16% of women with GDM and 6% of women without GDM were obese. Smoking during pregnancy was more frequent among women with GDM (18%) than among those without GDM (4%). Neonatal characteristics were comparable between the two groups. The difference in CIMT between offspring of women with and without GDM was of 0.00 mm (95% CI -0.01 to 0.01; p=0.96) and remained similar on adjustment for potential confounding factors, such as maternal prepregnancy body mass index, maternal education, smoking during pregnancy, family history of diabetes, as well as offspring's sex, age, and body surface area (0.00 mm (95% CI -0.02 to 0.01; p=0.45)).

Conclusions: We found no evidence of increased CIMT in neonates exposed to GDM. A longer-term follow-up that includes additional vascular measures, such as endothelial function or arterial stiffness, may shed further light on the cardiovascular health trajectories in children born to mothers with GDM.

Trial registration number: NCT02872974; Pre-results.

Keywords: cardiac epidemiology; cardiovascular imaging; diabetes in pregnancy; neonatology; paediatric cardiology.

Figure 1

Histograms of CIMT at birth, overall and by GDM exposure. This figure shows the distribution of CIMT values in our sample, overall (n=200) and by GDM exposure (non-GDM: n=99; GDM: n=101). The black line represents the kernel density estimate. CIMT, carotid intima–media thickness; GDM, gestational diabetes mellitus; n, number of participants.

Figure 2

Box plots of CIMT at birth by GDM exposure and assignment to a lifestyle and psychosocial intervention. This figure shows the distribution of CIMT in the offspring of women without GDM (non-GDM; n=99) and the offspring of women with GDM who were assigned to no intervention (GDM, non-I; n=48) or to a lifestyle and psychosocial intervention (GDM, I; n=53) as part of their participation in the MySweetHeart trial. The line inside the box represents the median value of the distribution, while the lower and upper boundaries of the box represent the first (Q1) and third (Q3) quartiles, respectively. The IQR corresponds to Q3–Q1. The whiskers extend from either side of the box up to 1.5*IQR (ie, Q1–1.5*IQR and Q3 +1.5*IQR). Outliers are depicted as circles. CIMT, carotid intima–media thickness; GDM, gestational diabetes mellitus; I, intervention; IQR, interquartile range; n, number of participants.

Figure 3

Illustration of the relationship of GDM with offspring’s CIMT at birth through a forest plot. The boxes represent the mean differences in CIMT between offspring of women with and without GDM (ie, GDM vs non-GDM). The horizontal lines represent the 95% CIs. The plot was constructed using regression estimates and models presented in table 2. Model specification: Model 1 is unadjusted, while Model 2 and Model 3 are adjusted for various factors as described in the methods and footnote of table 2. CI, confidence interval; CIMT, carotid intima–media thickness; GDM, gestational diabetes mellitus.