Effect of maternal gestational diabetes on the cardiovascular risk factor profile of infants at 1 year of age

The Impact of Maternal Preeclampsia and Hyperglycemia on the Cardiovascular Health of the Offspring: A Systematic Review and Meta-analysis

OBJECTIVES

The objective of this review was to assess the impact of maternal preeclampsia or hyperglycemia on the body composition and cardiovascular health in the offspring.

STUDY DESIGN

We conducted a systematic review utilizing PubMed, EBSCO, CINAHLPlus, Cochrane Library, and Web of Science to include all studies assessing the impact of preeclampsia/eclampsia and/or gestational/pregestational diabetes mellitus on the health of the offspring (children <10 years of age). The health measures included anthropometry, cardiac dimensions and function, and vascular function. We performed a meta-analysis using Review Manager software and computed net risk ratio (RR) with 95% confidence interval (CI) for dichotomous data and mean difference (MD) with 95% CI for continuous data.

RESULTS

There were 6,376 studies in total, of which 45 were included in the review and 40 in the meta-analysis. The results demonstrated higher birth weight (MD: 0.12 kg; 95% CI: 0.06-0.18) and systolic and diastolic blood pressure (BP; MD: 5.98 mm Hg; 95% CI: 5.64-6.32 and MD: 3.27 mm Hg; 95% CI: 0.65-5.89, respectively) in the offspring of mothers with gestational diabetes compared to controls. In contrast, the offspring of mothers with preeclampsia had lower birth weight (MD: -0.41 kg; 95% CI: -0.7 to -0.11); however, they had increased systolic (MD: 2.2 mm Hg; 95% CI: 1.28-3.12) and diastolic BP (MD: 1.41 mm Hg; 95% CI: 0.3-2.52) compared to controls. There is lack of data to conduct a meta-analysis of cardiac morphology, functional, and vascular imaging parameters.

CONCLUSION

These findings suggest that the in-utero milieu can have a permanent impact on the body composition and vascular health of the offspring. Future work warrants multicenter prospective studies to understand the mechanism and the actual effect of exposure to maternal hyperglycemia and high BP on the cardiovascular health of the offspring and long-term outcomes.

KEY POINTS

· Adverse in-utero exposures may have an impact on cardiovascular risk in children.. · Maternal hyperglycemia/preeclampsia lead to changes in birthweight and BP.. · Limited echocardiographic and vascular imaging data in these cohorts necessitates future work..

Consequences of gestational diabetes mellitus on neonatal cardiovascular health: MySweetHeart Cohort study

BACKGROUND

Hyperglycaemic disorders of pregnancy are associated with offspring cardiovascular alterations.

METHODS

MySweetHeart cohort study aimed to assess the effect of maternal gestational diabetes (GDM) on offsprings' cardiovascular health. Newborns underwent clinical and echocardiographic examinations between 2016 and 2020.

RESULTS

Compared to mothers without GDM (n = 141), mothers with GDM (n = 123) were more likely to have had GDM in previous pregnancies and had higher weight, BMI, blood glucose, and HbA1c. Newborns of both groups showed similar clinical characteristics. Echocardiography was performed on the 3rd (interquartile range, IQR, 2nd-4th) day of life in 101 offsprings of mothers without and 116 offsprings of mothers with GDM. Left ventricular (LV) mass was similar. Children born to mothers with GDM had a thicker posterior LV wall (z-score +0.15, IQR -0.38/0.62, versus +0.47, IQR -0.11/+1.1, p = 0.004), a smaller end-systolic (1.3 mL, IQR 1.0-1.5 mL, versus 1.4 mL, IQR 1.2-1.8 mL, p = 0.044) but a similar end-diastolic LV volume. They also had shorter tricuspid valve flow duration and aortic valve ejection time, lower tricuspid E-wave and pulmonary valve velocities.

CONCLUSIONS

Newborns of mothers with or without GDM had similar clinical characteristics and LV mass. However, some echocardiographic differences were detected, suggesting an altered myocardial physiology among infants of mothers with GDM.

REGISTRATION

ClinicalTrials.gov (NCT02872974).

IMPACT

Hyperglycaemic disorders of pregnancy are known to be associated with offspring cardiovascular alterations. Clinical characteristics and estimated left ventricular (LV) mass were similar in children issued from mothers with and without gestational diabetes (GDM). Children born to mothers with GDM had a thicker posterior LV wall and a smaller end-systolic LV volume. Although LV mass is not different, myocardial physiology may be altered in these infants. Further studies should investigate the endothelial function of this population and the cardiovascular evolution of these children over time.

Maternal gestational diabetes and childhood hyperlipidemia

AIMS

Aim of this study is to assess dyslipidemia risk between children exposed to maternal gestational diabetes mellitus (GDM) and those not exposed.

METHODS

We recruited 1144 mother-child pairs (572 GDM and 572 non-GDM women matched by their offspring's age and sex). The age of offspring ranged from 3 to 9 years old. We used general linear models to compare mean values of different lipid profiles among children born to mothers with and without GDM. Logistic regression models were used to assess associations of maternal GDM with abnormal lipid profiles in offspring.

RESULTS

After adjustment for maternal and children's characteristics, children born to mothers with GDM had lower mean values of high-density-lipoprotein (HDL) cholesterol (1.40 ± 0.01 vs. 1.50 ± 0.01; p < 0.001) and higher mean levels of triglycerides/HDL cholesterol ratio (0.37 ± 0.01 vs. 0.35 ± 0.01; p < 0.05) in comparison with their counterparts born to mothers without GDM. Multivariate-adjusted odds ratios among children exposed to mothers with GDM compared with the counterparts were 2.11 (95% confidence interval [CI 1.15-3.88]) for low HDL cholesterol and 1.35 (95% CI 1.00-1.81) for high triglycerides/HDL cholesterol ratio, respectively.

CONCLUSIONS

Maternal GDM was associated with an increased risk of hyperlipidemia in the offspring during early childhood aged from 3 to 9 years old.

Determinants of insulin resistance in children exposed to gestational diabetes in utero

BACKGROUND

The evolution of increased adiposity and cardiometabolic risk in offspring exposed to maternal gestational diabetes (GDM) is not well understood.

OBJECTIVE

(a) To evaluate the impact of in utero exposure to GDM and maternal weight status on homeostasis model assessment of insulin resistance (HOMA-IR) in the offspring longitudinally from 1 to 3 years of age and (b) to compare body mass index (BMI) and HOMA-IR in GDM and non-GDM exposed offspring at 1 and 3 years of age.

METHODS

A prospective cohort of children born to mothers with and without GDM underwent metabolic characterization between birth and 3 years of age.

RESULTS

In the overall cohort, weight gain between birth and 3 years of age was positively associated with HOMA-IR (β = 0.1491, P = .02), independent of maternal weight status. HOMA-IR was not different between GDM and non-GDM exposed children from 1 to 3 years of age; however, BMI z score was greater in GDM exposed children at 3 years of age. Among non-GDM exposed children, male sex predicted a 35.1% lower HOMA-IR (P = .03). In GDM exposed offspring, a 1 unit increase in maternal insulin sensitivity predicted a 20.8% decrease in HOMA-IR (P = .002).

CONCLUSIONS

Overall, weight gain in the first 3 years of life was positively associated with HOMA-IR, while insulin sensitivity of mothers with GDM negatively predicted HOMA-IR in the offspring. Our findings indicate the need to target weight trajectories in early life, as well as maternal factors during gestation to improve metabolic outcomes in the offspring, particularly those exposed to GDM.

Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: systematic review and meta-analysis

Gestational diabetes mellitus (GDM) is a pregnancy complication that affects one in seven pregnancies. Emerging evidence demonstrates that children born of pregnancies complicated by GDM may be at increased risk of cardiovascular disease (CVD) in adulthood. Therefore, the aim of this study was to determine cardiovascular risk factors in offspring exposed to GDM in utero. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Information was extracted on established CVD risk factors including blood pressure, lipids, blood glucose, fasting insulin, body mass index (BMI), and endothelial/microvascular function. The review protocol is registered in PROSPERO (CRD42018094983). Prospective and retrospective studies comparing offspring exposed to GDM compared to controls (non-GDM pregnancies) were considered. We included studies that defined GDM based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) definition, or prior definitions. The PRISMA guidelines were followed in conducting this systematic review. Methodological quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Study selection, data extraction, and quality assessment were done by two independent reviewers. The data were pooled using a random-effects model. Of 59 eligible studies, 24 were included in the meta-analysis. Offspring exposed to GDM had higher systolic blood pressure (mean difference (MD): 1.75 mmHg, 95% CI 0.57-2.94; eight studies, 7264 participants), BMI z-score (MD 0.11, 95% CI 0.02-0.20; nine studies, 8759 participants), and glucose (standard MD 0.43, 95% CI 0.08-0.77; 11 studies, 6423 participants) than control participants. In conclusion, offspring exposed to GDM have elevated systolic blood pressure, BMI, and glucose. Those exposed to GDM in utero may benefit from early childhood blood pressure measurements.

Gestational diabetes alters microRNA signatures in human feto-placental endothelial cells depending on fetal sex

MicroRNAs (miRNAs), small non-coding RNAs, have emerged as important, epigenetic regulators of endothelial function. Metabolic disturbances such as diabetes alter miRNA expression. In adults, the miRNA transcriptome as well as endothelial function differ between the sexes. Here, we hypothesized that metabolic disturbances associated with gestational diabetes (GDM) alter miRNA signatures in feto-placental endothelial cells (fpEC), dependent on fetal sex. We isolated human primary fpEC after normal and GDM-complicated pregnancies with male and female neonates and screened for differential miRNA expression using next-generation miRNA sequencing. To test for miRNAs commonly regulated in fpEC of female and male progeny, data were stratified for fetal sex and maternal body mass index (BMI). Analyses were also performed separately for female and male fpEC, again accounting for maternal BMI as covariate. Potential biological pathways regulated by the altered set of miRNAs were determined using mirPath software. Maternal GDM altered 26 miRNA signatures when male and female fpEC were analyzed together. Separate analysis of male versus female fpEC revealed 22 GDM affected miRNAs in the females and only 4 in the males, without overlap. Biological functions potentially modulated by the affected miRNAs related to ‘Protein Processing in Endoplasmic Reticulum’ and ‘Proteoglycans in Cancer’. Maternal GDM alters miRNA signatures in fpEC, and biological functions affected by these miRNAs relate to well-known adverse functional consequences of diabetes on endothelium. GDM effects were highly dependent on fetal sex with miRNA signatures in female fpEC being more susceptible to metabolic derangements of GDM than miRNAs in male fpEC.

Gestational Diabetes Alters Functions in Offspring's Umbilical Cord Cells With Implications for Cardiovascular Health

Because noncommunicable diseases such as type 2 diabetes mellitus have their roots in prenatal development and conditions such as maternal gestational diabetes mellitus (GDM), we aimed to test this hypothesis in primary cells derived from the offspring of mothers with GDM compared with control subjects. We have assessed primary umbilical cord-derived cells such as human umbilical vein endothelial cells (HUVECs) and Wharton's jelly-derived mesenchymal stem cells from the offspring of mothers with and without GDM. We have compared the primary isolates in cell-based assays measuring proliferation, mitochondrial oxygen consumption, and the ability to support blood vessel growth. We conducted gene expression microarray studies with subsequent pathway analysis and candidate gene validation. We observed striking differences between the two groups, such as lower metabolic rates and impairment of endothelial tube formation in cells with GDM background. HUVECs from subjects with maternal GDM have lower expression of the antiapoptotic protein BCL-xL, suggesting compromised angiogenic capabilities. Comparative gene expression analysis revealed blood vessel formation as a major pathway enriched in the GDM-derived HUVECs with the surface marker CD44 as a gene underexpressed in the GDM group. Functional validation of CD44 revealed that it regulates tube formation in HUVECs, thereby providing insights into a pathway imprinted in primary umbilical cord-derived cells from GDM offspring. Our data demonstrate that primary cells isolated from the umbilical cord of offspring born to mothers with GDM maintain metabolic and molecular imprints of maternal hyperglycemia, reflecting an increased risk for cardiovascular disease later in life.

Association between metabolic deteriorations and prior gestational diabetes according to weight status

OBJECTIVE

The aim of the present study is to investigate the effect of prior gestational diabetes mellitus (GDM) on glucose and insulin homeostasis according to weight status.

METHODS

The analysis included 299 women, 216 with [GDM(+)] and 83 without prior GDM [GDM(-)]. The mean time between pregnancy and testing was 3.9 years. Glucose values were obtained from a 2-h 75 g oral glucose tolerance test (OGTT). Body composition was measured by dual-energy X-ray.

RESULTS

In women with normal BMI, fasting glucose, 2-h post-OGTT glucose, and HbA1 were higher for GDM(+) (P<0.05). Normal-weight women with GDM(+) presented lower HOMA-IS, insulin secretion, and insulinogenic index (P<0.05) compared to GDM(-). Body fat and android fat mass were higher, gynoid fat mass was similar, and lean body mass was decreased in GDM(+) vs. GDM(-) with normal weight (P<0.05). A greater proportion of GDM(+) with overweight/obesity had prediabetes (72.1%) or type 2 diabetes (T2D) (21.7%) vs. GDM(-) and overweight/obesity (17.1 and 2.4%) or GDM(+) and normal weight (60.5 and 14.0%).

CONCLUSIONS

A combination of GDM and overweight/obesity is associated with T2D-related metabolic deteriorations. Nevertheless, normal-weight women with GDM(+) had increased android fat and greater metabolic complications, suggesting that women with prior GDM should benefit from lifestyle intervention, regardless of their weight status.

Antepartum determinants of rapid early-life weight gain in term infants born to women with and without gestational diabetes

OBJECTIVE

Rapid weight gain in the first 3 months of life has been associated with an unfavourable cardio-metabolic phenotype in adulthood. However, little is known about the antepartum determinants of this rapid weight gain, which may reflect key developmental exposures that program metabolic pathways. Thus, we sought to characterize the antepartum determinants of rapid weight gain in the first 3 months of life in infants exposed to gestational diabetes mellitus (GDM), a patient population at risk for early cardio-metabolic disease.

DESIGN

Prospective observational cohort study.

PATIENTS

Pregnant women with (n = 90) and without GDM (n = 250) underwent detailed antepartum metabolic characterization, followed by assessment of their term offspring at age 3 months.

MEASUREMENTS

Rapid infant weight gain in the first 3 months was defined as weight gain ≥ 0·5 SD.

RESULTS

No features of maternal metabolic function in pregnancy (including insulin sensitivity, lipid profile, adiponectin, leptin and C-reactive protein) were associated with infant weight gain in either the GDM or non-GDM group. Interestingly, although all infants were born at term (≥37 weeks), length of gestation was inversely associated with weight gain at 3 months in the infants of women with GDM (β = -148·5, P = 0·01). In these infants, length of gestation <39 weeks was an independent predictor of rapid weight gain (OR = 7·9, 95%CI 1·7-38, P = 0·009) in the fully adjusted model. These associations were not observed in infants of women without GDM.

CONCLUSIONS

Delivery before 39 weeks is independently associated with rapid weight gain in the first 3 months of life in term infants of women with GDM and hence may be an antepartum marker of future cardio-metabolic risk.

A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease

This article is a comprehensive review on developmental origins of health and disease regarding various factors related to the origins of cardiovascular diseases from early life. It presents a summary of the impacts of various factors such as epigenetics; gene-environment interaction; ethnic predisposition to cardiovascular diseases and their underlying risk factors; prenatal factors; fetal programming; maternal weight status and weight gain during pregnancy; type of feeding during infancy; growth pattern during childhood; obesity; stunting; socioeconomic status; dietary and physical activity habits; active, secondhand, and thirdhand smoking, as well as environmental factors including air pollution and global climate change on the development and progress of cardiovascular diseases and their risk factors. The importance of early identification of predisposing factors for cardiovascular diseases for primordial and primary prevention of cardiovascular diseases from early life is highlighted.