Long-term cardiometabolic consequences among adolescent offspring born to women with type1 diabetes

Published:December 03, 2021DOI:https://doi.org/10.1016/j.pcd.2021.11.008

      Highlights

      • Adolescent born to diabetic women are at risk of developing metabolic syndromes.
      • Obesity, hypertension and dyslipidemia are the major risks factors.
      • The risk of obesity and hypertension are more prevalent in females than males.

      Abstract

      Aim

      The aim of this study was to compare cardiometabolic measures between adolescents born to women with and without type1diabetes.

      Methods

      In this cross-sectional study, 103 adolescents (51 males) aged 14−19 years, born to women with type1diabetes were enrolled in the study. Body mass index, blood pressure, urine microalbumin to creatinine ratio, hemoglobin A1c, serum urate, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, and estimated glomerular filtration rate (eGFR) were measured in all. The results were compared with 98 adolescents born to non-diabetic women.

      Results

      In multiple linear regression models, adolescent offspring of women with type 1 diabetes had significantly higher blood pressure (Odds ratio [OR] 2·45; 95% Confidence interval [CI] 2.1–2.8, hypertension (OR 2.52; 95% CI 1.99–3.01), body mass index (OR 2.22; 95% CI: 1.76–2.69), elevated total cholesterol (OR 1.5; 95% CI 0.2–2.9), low-density lipoprotein cholesterol (OR·33; 95% CI 1.06–1.64), triglyceride (OR 1.34; 95% CI: 1.05–1.70), eGFR (OR 0.96 ;95% CI 0.81–1.11) and microlabuminuria (OR 1.1; 95% CI: 0.87–1.12) compared to offspring of women without diabetes.

      Conclusion

      The study demonstrates a strong correlation between maternal exposure to type1diabetes and higher risk of developing obesity, hypertension, dyslipidemia, eGFR, and microalbumiuria in the adolescent offspring.

      Graphical abstract

      Abbreviations:

      eGFR (estimated glomerular filtration rate), TC (total cholesterol), LDLC (low density lipoprotein cholesterol), HDLC (high density lipoprotein cholesterol), TG (triglyceride)

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fraser A.
        • Lawlor D.A.
        Long-term health outcomes in offspring born to women with diabetes in pregnancy.
        Curr. Diab. Rep. 2014; 14: 589https://doi.org/10.1007/s11892-013-0489-x
        • Tam W.H.
        • WanMa R.C.
        • Ozaki R.
        • Lin A.M.
        • et al.
        In utero exposure to maternal hyperglycemia increases childhood cardiometabolic risk in offspring.
        Diabetes Care. 2017; 40: 679-686
        • Khalil C.B.
        • Travert F.
        • Fetita S.
        • Rouzet F.
        • et al.
        Fetal exposure to maternal type 1 diabetes is associated with renal dysfunction at adult age.
        Diabetes. 2010; 59: 2631-2636
        • Lynch S.
        • Wright C.
        Sirenomelia, limb reduction defects, cardiovascular malformation, and renal agenesis in an infant born to a diabetic mother.
        Clin Dysmorpho. 1997; 6: 75-80
        • Vrachnis N.
        • Antonakopoulos N.
        • Iliodromiti Z.
        • Dafopoulos K.
        • et al.
        Impact of maternal diabetes on epigenetic modificatins leading to diseases in the offspring.
        Exp. Diabetes Res. 2012; (538474)https://doi.org/10.1155/2012/538474
        • Bayoumy S.
        • Habib M.
        • Abdelmageed R.
        Impact of maternal diabetes and obesity on fetal cardiac functions.
        Egypt Heart J. 2020; 72: 46https://doi.org/10.1186/S43044-020-00077-X
        • Moafi M.
        • Assadi F.
        • Heshmat R.
        • Kelishadi R.
        • et al.
        Impact of dyslipidemia on estimated glomerular filtration rate in apparently health children and adolescents: the CASPIAN-V study.
        World J. Pediatr. 2019; 15: 471-475
        • Assadi F.
        The growing epidemic of chronic kidney disease: preventive strategies to delay the risk for progression to end-stage renal disease.
        Adv. Exp. Med. Biol. 2019; 1121: 57-59
        • West N.A.
        • Crume T.L.
        • Maligie M.A.
        • Dabelea D.
        Cardiovascular risk factors in children exposed to maternal diabetes in utero.
        Diabetologia. 2011; 54: 504-507
        • Yongfu Yu.
        • Onyebuchi A.R.
        • Zeyan L.
        • Cnattingius S.
        • et al.
        Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up.
        BMJ. 2019; 367: l6398https://doi.org/10.1136/bmj.16398
        • Assadi F.
        Strategies to reduce the incidence of chronic kidney disease in children: time for action.
        J. Nephrol. 2013; 26: 41-47
        • Manderson J.G.
        • Mullan B.
        • Patterson C.C.
        • Hadden D.R.
        • et al.
        Cardiovascular and metabolic abnormalities in the offspring of diabetic pregnancy.
        Diabetologia. 2002; 45: 991-996
        • Gautier J.F.
        • Porcher R.
        • Abi Khalil C.
        • Bellilli-Munoz N.
        • et al.
        Kidney dysfunction in adult offspring exposed in utero to type 1 diabetes is associated with alterations in genome-wide DNA methylation.
        PLoS One. 2015; 10e0134654https://doi.org/10.1371/journal.pone.0134654
        • Vlachova Z.
        • Bytoft B.
        • Knorr S.
        • Clausen T.D.
        • et al.
        Increased metabolic risk in adolescent offspring of mothers with type-1 diabetes: the EPICOM study.
        Diabetologia. 2015; 58: 1454-1463
        • Knorr S.
        • Bytoft B.
        • Lohse Z.
        • Boisen A.
        • et al.
        Fatty liver among adolescent offspring of women with type 1 diabetes (the EPICOM Study).
        Diabetes Care. 2019; 8: 1560-1568
        • Pitchika A.
        • Jolink M.
        • Winkler C.
        • Hummel S.
        • et al.
        Associations of maternal type 1 diabetes with childhood adiposity and metabolic health in the offspring: a prospective cohort study.
        Diabetologia. 2018; https://doi.org/10.1007/s00125-018-4688-x
        • Baum M.
        Role of the kidney in the prenatal and early postnatal programming of hypertension.
        Am. J. Physiol. Renal Physiol. 2010; 298: F235-F247
        • Vehasakari V.M.
        Prenatal programming of kidney disease.
        Curr. Opin. Pediatr. 2010; 22: 176-182
      1. Well-Care Questionnaire-for teens ages 13 to 17-Kaiser Permanente. https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/member-service. (Accessed 18 July 2018).

        • Godin G.
        • Shephard R.J.
        A simple method to assess exercise behavior in the community.
        Can. J. Appl. Sport Sci. 1985; 10: 141-146
        • Schmidt M.D.
        • Freedson P.S.
        • Pekow P.
        • Roberts D.
        • Sternfeld B.
        • hasan-Taber L.
        Validation of the Kaiser physical activity survery in pregmnant women.
        Med. Sci. Sports Excec. 2006; 38: 42-50
        • American Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diabetic Care. 2012; 35: 564-571
        • National Institute for Health and Care Excellence
        Type 1 Diabetes in Adults: Diagnosis and Management.
        2015
        • Fossati P.
        • Prencipe L.
        • Berti G.
        Enzymatic creatinine assay: a new colorimetricmethod based on hydrogen peroxide measurement.
        Clin. Chem. 1983; 29: 1494-1496
        • Assadi F.
        Quantitation of microalbumiuria using random urine samples.
        Pediatr. Nephrol. 2002; 17: 269-271
      2. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. https://cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_children_bmi.html. (Accessed 29 June 2020).

        • Flynn J.T.
        • Kaelber D.C.
        • Baker-Smith C.M.
        • Blowey D.
        • et al.
        Subcommittee on screening and management of high blood pressure in children. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.
        Pediatrics. 2017; 140e20171904https://doi.org/10.1542/peds.2017-1904
        • Schwartz G.J.
        • Munoz A.
        • Schneider M.F.
        • Mak R.H.
        • et al.
        New equations to estimate GFR in children with CKD.
        J. Am. Soc. Nephrol. 2009; 20: 629-667
        • Regnault N.
        • Gillmam M.W.
        • Rifas-Shiman S.L.
        • Eggleston E.
        • et al.
        Sex-specific associations of gestational glucose tolerance with childhood body composition.
        Diabetes Care. 2013; 36: 3045-3053
        • Lingwood B.E.
        • Henry A.M.
        • d’Emden M.C.
        • Fullerton M.M.
        • et al.
        Determinant of body fat in infants of women with gestational diabetes mellitus differs with fetal sex.
        Diabetes Care. 2011; 34: 2581-2585
        • Bahado-Singh R.O.
        • Mele L.
        • Landon M.B.
        • Ramin S.M.
        • et al.
        Fetal male gender and the benefits of treatment of mild gestational diabetes mellitus.
        Am. J. Obstet. Gynecol. 2012; 206 (422.el–422.e5)
        • Boerschmann H.
        • Pfluger M.
        • Henneberger L.
        • Ziegler A.G.
        • et al.
        Prevalence and predictors of overweight and insulin resistance in offspring of mothers with gestational diabetes mellitus.
        Diabetes Care. 2010; 3: 1845-1849
        • Buinauskiene J.
        • Baliutavviciene D.
        • Zalinkenvicius R.
        Glucose intolerance of 2-to 5-yr-old offspring of diabetic mothers.
        Pediatr. Diabetes. 2004; 5: 143-146
        • Luo H.
        • Chen C.
        • Guo L.
        • Xu Z.
        • et al.
        Exposure to maternal diabetes mellitus causes renal dopamine D1 receptor dysfunction and hypertension in adult rat offspring.
        Hypertension. 2018; 72: 962-970
        • Kato M.
        • Natarajan R.
        Epigenetics and epigenomics in diabetic kidney disease and metabolic memory.
        Nat. Rev. Nephrol. 2019; 15: 327-345
        • Pasquier J.
        • Hoarau-Vechot J.
        • Fakhro K.
        • Rafi A.
        • et al.
        Epigenetic and cardiovascular disease in diabetes.
        Curr. Diab. Rep. 2015; 15: 108https://doi.org/10.1007/s11892-015-0677-3
        • Pettitt D.J.
        • Aleck K.A.
        • Baird H.R.
        • Carraher M.J.
        • et al.
        Congenital susceptibility to NIDDM. Role of intrauterine environment.
        Diabetes. 1988; 37: 622-628
        • Eriksson R.
        Importance of genetic predisposition and maternal environment for the occurrence of congenital malformations in offspring of diabetic rats.
        Teratology. 1988; 37: 365-374
        • He C.
        • Zalups R.K.
        • Striker G.E.
        • Striker L.J.
        Molecular analysis of spontaneous glomerulosclerosis in Os/+mice, a model with reduced nephron mass.
        Am. J. Physiol. 1955; 269: F266-F273
        • Brenner B.M.
        • Garcia D.L.
        • Anderson S.
        Glomeruli and blood pressure: less of one, more of the other?.
        Am. J. Hypertens. 1988; 1: 335-347
        • Kelishadi R.
        • Qorbani M.
        • Assadi F.
        • Motlag M.E.
        • et al.
        Glomerular hyperfiltration as predictor of cardiometabolic risk factors among children and adolescent: the childhood and adolescence surveillance and prevention of adult-V study.
        Int. J. Prev. Med. 2018; 9: 33https://doi.org/10.4103/ijpvm.IJPVM_38+18
        • D’Agati V.D.
        • Chagnac A.
        • de Vrites A.P.
        • Levi M.
        • et al.
        Obesity related glomerulopathy: clinical and pathologic characteristics and pathogenesis.
        Nat. Rev. Nephrol. 2016; 12: 453-471
        • Wuerzbwer G.
        • Pruijm M.
        • Maillard M.
        • Bovet P.
        • et al.
        Marked association between obesity and glomerular hyperfiltration: a cross sectional study in an African American population.
        Am. J. Kidney Dis. 2010; 56: 303-312