cardiovascular; gestational diabetes; epidemiology; pediatric; fetus
Epure Adina Mihaela, Chiolero Arnaud (2019), From detection early in life to the primordial prevention of elevated blood pressure, in The Journal of Clinical Hypertension
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Epure Adina Mihaela, Leyvraz Magali, Mivelaz Yvan, Di Bernardo Stefano, da Costa Bruno R, Chiolero Arnaud, Sekarski Nicole (2018), Risk factors and determinants of carotid intima-media thickness in children: protocol for a systematic review and meta-analysis, in BMJ Open
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Horsch Antje, Gilbert Leah, Lanzi Stefano, Gross Justine, Kayser Bengt, Vial Yvan, Simeoni Umberto, Hans Didier, Berney Alexandre, Scholz Urte, Barakat Ruben, Puder Jardena J (2018), Improving cardiometabolic and mental health in women with gestational diabetes mellitus and their offspring: study protocol for MySweetHeart Trial , a randomised controlled trial, in BMJ Open
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Di Stefano B Mivelaz Y Epure MA Vial Y Simeoni U Bovet P Estoppey SY Chiolero A Sekarski N (2017), Assessing the consequences of gestational diabetes mellitus on offspring’s cardiovascular health: MySweetHeart Cohort study, in BMJ Open
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BackgroundMaternal hyperglycemic disorders, including type 1 and type 2 diabetes mellitus (T1/T2DM) and gestational diabetes mellitus (GDM), are increasing in the population largely due to the obesity epidemic. Maternal DM is associated with significant fetal and neonatal morbidity such as large for gestational age (LGA) and congenital malformations. It is also associated with cardiovascular alterations in the newborn such as cardiac left ventricular hypertrophy. Offspring exposed to maternal diabetes during fetal life may have higher prevalence of impaired glucose tolerance in childhood and adolescence and of obesity and metabolic syndrome in adulthood. That may contribute to an intergenerational dissemination of the diabetes epidemic. Further, within a Developmental Origin of Health and Disease (DOHaD) framework, maternal DM as well as GDM may be involved in the fetal programming of long-term cardiovascular health. However, evidence is sparse and the effect of GDM on cardiovascular health is not known. Recently, a large cohort study showed that maternal hyperglycemia less severe than in T1/T2DM was associated with adverse perinatal outcomes (LGA, neonatal hyperinsulinism, hypoglycemia). Based on this study, diagnostic criteria of GDM have changed and universal screening for GDM has been recommended, resulting in a much greater proportion of pregnant women diagnosed with this condition. It is therefore timely to assess the effect of GDM, defined using these new diagnostic criteria, on offspring’s early life cardiovascular health. In particular, the effect of GDM on surrogate markers for cardiovascular diseases (CVD) early in life has never been studied. ObjectivesOur objectives are to assess the effect of GDM on offspring cardiovascular health early in life, namely on (i) the surrogate markers of CVD at birth [left ventricular mass index (LVMI) and subclinical atherosclerosis (carotid intima-media thickness; cIMT)] (primary outcomes) and (ii) the cardiovascular structure and function during the fetal period (secondary outcomes).MethodologyWe will conduct a cohort study of 200 pregnant women, 100 with GDM and 100 without GDM, and their offspring. Pregnant women will be recruited at the antenatal care clinic of the University Hospital of Lausanne, Switzerland. In women without preexisting DM, GDM will be diagnosed if their fasting plasma glucose is equal or above 5.1 mmol/l or if they fulfill the new international criteria using the 75g oral glucose tolerance test. In addition to the usual exams conducted during pregnancy, a fetal echography will be done between the 30th and 34th week of gestation to assess the fetal growth, the cardiovascular system structure and function, the feto-maternal circulation, and the liver volume. At birth and in the early post-natal period, cardiac morphology (left ventricular mass index; LVMI) and function and carotid intima-media thickness (cIMT) will be measured. Further, a cord blood sample will be drawn to assess various CVD risk markers. This study is limited to the comparison of the effects of GDM on cardiovascular health during the fetal and early neonatal period. A long-term follow-up of the offspring is anticipated to determine the effect of GDM on the development of cardiovascular health during infancy and childhood (not part of the funding request).Anticipated resultsWe hypothesize that GDM is associated with a larger LVMI and a larger cIMT at birth (primary outcomes), as well as with fetal cardiovascular alterations and adverse neonatal cardio-metabolic risk factors (secondary outcomes).SignificanceWithin a DOHaD framework, our study allows better understand the effect of GDM on the offspring’s fetal and post-natal development of cardiovascular health. Improved knowledge in this area has the potential to help prevent early life and intergenerational cardio-metabolic effects of maternal hyperglycemic disorders.