母亲妊娠期糖尿病与儿童早期心血管系统改变的关联。

Associations of maternal gestational diabetes mellitus with alterations in cardiovascular system in early childhood.

机构信息

Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Diabetes Metab Res Rev. 2022 Sep;38(6):e3551. doi: 10.1002/dmrr.3551. Epub 2022 Jun 7.

DOI:10.1002/dmrr.3551

PMID:35638862

Abstract

AIMS

The association of maternal gestational diabetes mellitus (GDM) with childhood cardiovascular alterations is not well established. This study aims to test the hypothesis that prenatal exposure to GDM is associated with vascular and cardiac alterations in early childhood.

METHODS

In a population-based prospective cohort among 1094 mothers and their offspring, GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups criteria. Childhood blood pressure (BP) measurement, echocardiography and vascular ultrasound were performed using standardised methods at 4 years old. The associations between maternal GDM and childhood cardiovascular outcomes were modelled using linear regression and binary logistic regression. Mediation analysis was conducted to test the potential mediators.

RESULTS

Maternal GDM was associated with higher systolic BP (SBP; β, 1.20; [0.11, 2.28]), lower left ventricular end-diastolic diameter (LVEDD; β, -0.36; [-0.71, -0.01]), lower end-diastolic volume (EDV; β, -1.42; [-2.71, -0.13]) and increased risk of high blood pressure (HBP, OR = 1.522; 95% CI, 1.023 to 2.264) in offspring at the age of 4 years. After stratification by sex, the association remained strong only in male offspring (SBP: β, 1.94; [0.37, 3.51]; LVEDD: β, -0.60; [-1.09, -0.12]; EDV: β, -2.09; [-3.86, -0.31]; HBP: OR = 1.797; 95% CI, 1.063 to 3.037) and was independent of maternal and child characteristics. However, carotid intima-media thickness (cIMT) was not associated with maternal GDM. Mediation analysis showed that the effects on childhood cardiovascular alterations were attributable mostly to the direct effects of maternal GDM.

CONCLUSIONS

Our results provide evidence that maternal GDM is associated with offspring cardiovascular adaptations at preschool age. Further studies are needed to replicate our results and the long-term effect of these adaptations on later cardiovascular risks needs further investigation.

摘要

目的

母体妊娠期糖尿病（GDM）与儿童心血管改变之间的关联尚未得到充分证实。本研究旨在验证以下假设，即产前 GDM 暴露与儿童早期的血管和心脏改变有关。

方法

在一项基于人群的前瞻性队列研究中，共纳入了 1094 名母亲及其子女，根据国际妊娠糖尿病研究组标准诊断 GDM。在 4 岁时，使用标准化方法进行儿童血压（BP）测量、超声心动图和血管超声检查。使用线性回归和二项逻辑回归模型分析母亲 GDM 与儿童心血管结局之间的关联。进行中介分析以检验潜在的中介因素。

结果

母亲 GDM 与收缩压（SBP）升高（β，1.20；[0.11，2.28]）、左心室舒张末期直径（LVEDD）降低（β，-0.36；[-0.71，-0.01]）、舒张末期容积（EDV）减少（β，-1.42；[-2.71，-0.13]）以及儿童 4 岁时高血压（HBP）风险增加（OR=1.522；95%CI，1.023 至 2.264）相关。按性别分层后，这种关联仅在男性儿童中仍然强烈（SBP：β，1.94；[0.37，3.51]；LVEDD：β，-0.60；[-1.09，-0.12]；EDV：β，-2.09；[-3.86，-0.31]；HBP：OR=1.797；95%CI，1.063 至 3.037），且独立于母婴特征。然而，颈动脉内膜-中层厚度（cIMT）与母亲 GDM 无关。中介分析表明，儿童心血管改变的影响主要归因于母亲 GDM 的直接影响。