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Consequences of maternal gestational diabetes on offspring’s cardiovascular health

English title Consequences of maternal gestational diabetes on offspring’s cardiovascular health
Applicant Chiolero Arnaud
Number 163240
Funding scheme Project funding (Div. I-III)
Research institution Unité des Services de Santé IUMSP Centre Hospitalier Universitaire Vaudois
Institution of higher education University of Lausanne - LA
Main discipline Cardiovascular Diseases
Start/End 01.01.2016 - 31.12.2019
Approved amount 423'118.00
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All Disciplines (3)

Discipline
Cardiovascular Diseases
Paediatrics
Metabolic Disorders

Keywords (5)

cardiovascular; gestational diabetes; epidemiology; pediatric; fetus

Lay Summary (French)

Lead
Développement précoce de la santé cardiovasculaire d'enfants de mères avec diabète gestationnel
Lay summary
De plus en plus d'études suggèrent que la santé cardiométabolique des femmes enceintes a une influence sur la santé cardiométabolique de leurs enfants. Plus spécifiquement, il est possible que les enfants de femmes qui ont un diabète gestationnel développent plus facilement des troubles cardiovasculaires à long terme.  Dans cette étude, menée par des cardiologues pédiatres (PI: Dr N. Sekarski; CI: Dr Y. Mivelaz, Dr S. di Bernardo, Dr U. Simeoni), des épidémiologues (PI: Dr A. Chiolero; CI: Dr P. Bovet) et des obstétriciens (CI: Dr Y. Vial), la santé cardiovasculaire de 100 enfants de femmes avec diabète gestationnel sera comparée avec la santé cardiovasculaire de 100 enfants de femmes sans diabète gestationnel.  Des mesures de marqueurs de risque cardiovasculaire seront effectués in utero et à la naissance. Dans une perspective d'origine développementale de la santé, cette étude permettra de mieux comprendre l'effet intergénérationnel du diabète gestationnel sur la santé des enfants.
Direct link to Lay Summary Last update: 30.10.2015

Responsible applicant and co-applicants

Employees

Publications

Publication
Assessing the consequences of gestational diabetes mellitus on offspring’s cardiovascular health: MySweetHeart Cohort study
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, 0, e016972.

Collaboration

Group / person Country
Types of collaboration
Hôpital Sainte-Justine, Université de Montréal Canada (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel
Department of Epidemiology, McGill University Canada (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Service d’endocrinologie, diabétologie et métabolisme, Lausanne University Hospital Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Associated projects

Number Title Start Funding scheme
115691 Déterminants de la pression artérielle (PA) élevée chez les enfants dans un contexte d'épidémie d'obésité: études épidémiologiques en Suisse, au Canada et aux Seychelles 01.05.2007 SFGBM Fellowships for advanced researchers
176119 Improving metabolic and mental health in women with gestational diabetes and their offspring 01.11.2017 Project funding (Div. I-III)
109999 Prevalence and determinants of high blood pressure in children aged 11-13 years: a population-based study in Switzerland 01.09.2005 Project funding (Div. I-III)

Abstract

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.
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