Association of Maternal Glucose Concentrations During Pregnancy with Cardiovascular Alterations in Early Childhood: A Prospective Birth Cohort Study

Background: Maternal hyperglycemia has been associated with cardiovascular disease risks in offspring. Previous studies were mostly conducted to test this association in pregnancies with (pre)gestational diabetes mellitus. However, the association may not be limited to populations with diabetes only.Objectives: The aim of this study was to assess the association between gestational glucose concentrations in women without (pre) gestational diabetes mellitus and childhood cardiovascular alterations at the age of 4 y.Methods: Our study was based on the Shanghai Birth Cohort. Briefly, among 1016 nondiabetic mothers (age: 30.8 +/- 3.42 y; BMI: 21.3 +/- 2.94) and their offsprings (age: 4.41 +/- 0.22 y; BMI: 15.0 +/- 1.56; 53.0% males), results of maternal 1-h oral OGTT between 24 and 28 gestational weeks were obtained. Childhood blood pressure (BP) measurement, echocardiography, and vascular ultrasound were performed at 4 y old. Linear regression and binary logistic regression were conducted to test the association between maternal glucose and childhood cardiovascular outcomes.Results: Compared with children from mothers with glucose concentrations in the lowest quartile, children from mothers in the highest quartile had higher BP (systolic: 97.0 +/- 7.41 compared with 98.9 +/- 7.82 mmHg, P = 0.006; diastolic: 56.8 +/- 5.83 compared with 57.9 +/- 6.03 mmHg, P = 0.051) and lower left ventricular ejection fraction (92.5 +/- 9.15 compared with 90.8 +/- 9.16 %, P = 0.046). Also, higher maternal OGTT 1-h glucose concentrations across the full range were associated with higher childhood BP (systolic: l3: 0.56; 95% CI: 0.19, 0.93; diastolic: l3: 0.36; 95% CI: 0.05, 0.66). Logistic regression showed, compared with children from mothers in the lowest quartile, children from mothers in the highest quartile had a 58% (OR=1.58; 95% CI: 1.01, 2.47) higher odds of elevated systolic BP (>= 90th percentile).Conclusions: In a population without (pre)gestational diabetes mellitus, higher maternal OGTT 1-h glucose were associated with childhood cardiovascular structure and function alterations. Further studies are needed to assess whether interventions to reduce gestational glucose will mitigate subsequent cardiometabolic risks in offspring.