Long-term cardiovascular risk in relation to birth weight and exposure to maternal diabetes mellitus

Abstract

Background: Fetal exposure to maternal diabetes mellitus (DM) is associated with high birth weight, congenital heart malformations, childhood adiposity, DM, hypertension and dyslipidemia. The long term cardiovascular consequences of fetal exposure to maternal DM during pregnancy and high birth weight are not known.

Method: All individuals born in Sweden 1973-1988 (n = 1,551,603) were included in the study. The Swedish Medical Birth Register was merged with the Swedish Prescribed Drug Register. The association between offspring's adult consumption of cardiovascular medication and i) maternal DM during pregnancy and ii) birth weight were analyzed. Follow up time ranged between 17 and 36 years.

Results: Offspring exposed to maternal DM in utero had an increased risk of non-malformation cardiovascular disease (NMCVD), odds ratio (OR) 1.46 (95% confidence interval (CI) 1.16-1.83). After also excluding offspring with insulin dependent DM, no increased risk of NMCVD was found, OR 1.19 (95% CI 0.92-1.55). No increased risk of NMCVD was found in offspring born large for gestational age, OR 1.02 (95% CI 0.96-1.08). An increased risk of NMCVD was found in offspring born small for gestational age, OR 1.29 (95% CI 1.24-1.35).

Conclusions: Exposure to maternal DM during pregnancy was not associated with NMCVD in offspring at a maximum of 36 years of follow up. Low birth weight was confirmed to be a risk factor for NMCVD while high birth weight was not.

Keywords: Birth weight; Fetal programming; Maternal diabetes mellitus; Non-malformation cardiovascular disease.