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Associations of maternal glycemia in the first half of pregnancy with alterations in cardiac structure and function in childhood

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posted on 13.07.2020 by Rama J. Wahab, Vincent W.V. Jaddoe, Arno A.W. Roest, Liza Toemen, Romy Gaillard
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).

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