Maternal diabetes during pregnancy and carotid intima-media thickness in children

Abstract

Abstract Background Cardiovascular risk over the life course may be related to intrauterine risk factors, for instance, the exposure to maternal diabetes. Our objective was to systematically review studies that assessed the association of maternal diabetes during pregnancy and carotid-intima media thickness (CIMT), a marker of cardiovascular risk, in children. Methods We followed methods outlined in a published protocol for a systematic review on risk factors and determinants of CIMT in children (PROSPERO registration: CRD42017075169). Standardized mean differences in CIMT between offspring of women with and without diabetes during pregnancy were computed. Random effects meta-analyses were performed. The reliability of CIMT measurements was assessed. Funding SNSF 32003B-163240. Results Three observational studies involving 658 children were retained. Two studies were conducted in Europe and one in Australia. Age at CIMT assessment ranged from 2 days to 8 years. Two studies evaluated gestational diabetes during pregnancy and found no difference in CIMT among exposed children compared to controls (0.00 (95% CI: -0.41 to 0.41); 0.00 (95% CI; -0.28 to 0.28)). One study, that did not specify the type of diabetes evaluated, identified a higher CIMT (0.46 (95% CI; -0.07 to 1.00)). The pooled standardized mean difference in CIMT between offspring of women with and without diabetes during pregnancy was 0.08 (95% CI: -0.16 to 0.33; I2: 17.1%). Conclusions Overall, there is no clear association between maternal diabetes during pregnancy and offspring's CIMT. The degree of confidence in results is limited by the low number of studies, with relatively small sample sizes and a low number of participants exposed to maternal diabetes. Key messages Children exposed to maternal diabetes have no substantial alterations in vascular structure. More research is needed to inform primordial prevention of cardiovascular disease among these children.