OBJECTIVE:
Gestational
diabetes has been associated with offspring cardiac congenital malformations,
ventricular hypertrophy and diastolic dysfunction in large observational cohort
studies and experimental animal models. We assessed the associations of
maternal random glucose concentrations across the full range with childhood
cardiac ventricular structure and function.
RESEARCH
DESIGN AND METHODS: In
a population-based prospective cohort among 1,959 women and their offspring,
maternal random glucose concentrations were measured at a median 13.1 weeks
gestation (95% range 10.5; 16.8 weeks). We obtained offspring cardiac outcomes,
relative to body size, through cardiac Magnetic Resonance Imaging at 10 years.
RESULTS:
The
mean maternal random glucose concentration was 4.4 mmol/l (Standard Deviation
0.8). The highest quintile of maternal glucose concentrations, compared to the
lowest quintile, was associated with a lower childhood left ventricular mass (-0.19
Standard Deviation Score (SDS), 95% Confidence Interval (CI) -0.31; -0.07) and
left ventricular end-diastolic-volume (-0.17 SDS, 95% -0.28; -0.05). Also,
higher maternal glucose concentrations across the full range per 1 mmol/l increase
were associated with a lower childhood left ventricular mass and left
ventricular end-diastolic-volume (p-values≤0.05). Adjustment for maternal prepregnancy
BMI, gestational age and weight at birth or childhood BMI and blood pressure
did not influence the effect estimates. Maternal glucose concentrations were
not significantly associated with childhood right ventricular end-diastolic-volume
and left and right ventricular ejection fraction.
CONCLUSIONS:
Higher maternal random glucose concentrations in the first
half of pregnancy are associated with a lower childhood left ventricular mass
and left ventricular end-diastolic-volume, with the strongest associations for
childhood left ventricular mass. These associations were not explained by
maternal, birth or childhood characteristics. Further studies are needed to
replicate these findings using repeated maternal glucose measurements
throughout pregnancy and offspring cardiac outcomes throughout childhood and
adulthood.
Funding
The Generation R Study is financially supported by the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam and the Netherlands Organization for Health Research and Development. Romy Gaillard received funding from the Dutch Heart Foundation (grant number 2017T013), the Dutch Diabetes Foundation (grant number 2017.81.002) and the Netherlands Organization for Health Research and Development (NWO, ZonMW, grant number 543003109). Vincent Jaddoe received a grant from the Netherlands Organization for Health Research and Development (NWO, ZonMw-VIDI 016.136.361) and a European Research Council Consolidator Grant (ERC-2014-CoG-648916).