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Diabetologia
Published in: Diabetologia 11/2012

01-11-2012 | Article

The diabetic pregnancy and offspring blood pressure in childhood: a systematic review and meta-analysis

Authors: A. Aceti, S. Santhakumaran, K. M. Logan, L. H. Philipps, E. Prior, C. Gale, M. J. Hyde, N. Modi

Published in: Diabetologia | Issue 11/2012

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Abstract

Aims/hypothesis

Offspring of diabetic mothers have increased risk of the metabolic syndrome in adulthood. Studies examining BP in offspring of diabetic mothers have conflicting conclusions. We performed a systematic review and meta-analysis of studies reporting offspring BP in children born to diabetic mothers.

Methods

Citations were identified in PubMed. Authors were contacted for additional data. Systolic and diastolic BP in offspring of diabetic mothers and controls were compared. Subgroup analysis of type of maternal diabetes and offspring sex were performed. Fixed-effects models were used, and random-effects models where significant heterogeneity was present. Meta-regression was used to test the relationship between offspring systolic BP and prepregnancy BMI.

Results

Fifteen studies were included in the review and 13 in the meta-analysis. Systolic BP was higher in offspring of diabetic mothers (mean difference 1.88 mmHg [95% CI 0.47, 3.28]; p = 0.009). Offspring of mothers with gestational diabetes had similar diastolic BP to controls, but higher systolic BP (1.39 mmHg [95% CI 0.00, 2.77]; p = 0.05); results for type 1 diabetes were inconclusive and there were no separate data available on offspring of type 2 diabetic mothers. Male offspring of diabetic mothers had higher systolic BP (2.01 mmHg [95% CI 0.93, 3.10]; p = 0.0003) and diastolic BP (1.12 mmHg [95% CI 0.36, 1.88]; p = 0.004) than controls; in female offspring there was no difference (systolic: 0.54 mmHg [95% CI −1.83, 2.90], p = 0.66; diastolic: 0.51 mmHg [95% CI −1.07, 2.09], p = 0.52). The correlation between offspring systolic BP and maternal prepregnancy BMI was not significant (p = 0.37).

Conclusions/interpretation

Offspring of diabetic mothers have higher systolic BP than controls. Differences related to sex and type of maternal diabetes require further investigation.
Appendix
Available only for authorised users
Literature
1.
NICE (2009) NICE guideline 63: diabetes in pregnancy. Management of diabetes and its complications in pregnancy from the pre-conception to the postnatal period. In, www.​nice.​org.​uk/​CG063, accessed 3 August 2012
2.
Bell R, Bailey K, Cresswell T, Hawthorne G, Critchley J, Lewis-Barned N (2008) Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG 115:445–452PubMedCrossRef
3.
Dabelea D, Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF, McDuffie RS (2005) Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care 28:579–584PubMedCrossRef
4.
Weindling AM (2009) Offspring of diabetic pregnancy: short-term outcomes. Semin Fetal Neonatal Med 14:111–118CrossRef
5.
Catalano PM, McIntyre HD, Cruickshank JK et al (2012) The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 35:780–786PubMedCrossRef
6.
Simeoni U, Barker D (2009) Offspring of diabetic pregnancy: long-term outcomes. Semin Fetal Neonatal Med 14:119PubMedCrossRef
7.
8.
Freinkel N, Metzger BE (1978) Pregnancy as a tissue culture experience: the critical implications of maternal metabolism for fetal development. Ciba Found Symp: 3–28
9.
Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC (2010) Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 362:485–493PubMedCrossRef
10.
Pettitt DJ, Aleck KA, Baird HR, Carraher MJ, Bennett PH, Knowler WC (1988) Congenital susceptibility to NIDDM. Role of intrauterine environment. Diabetes 37:622PubMedCrossRef
11.
Bunt JC, Tataranni PA, Salbe AD (2005) Intrauterine exposure to diabetes is a determinant of hemoglobin A(1)c and systolic blood pressure in Pima Indian children. J Clin Endocrinol Metab 90:3225–3229PubMedCrossRef
12.
Vitale C, Mendelsohn ME, Rosano GM (2009) Gender differences in the cardiovascular effect of sex hormones. Nat Rev Cardiol 6:532–542PubMedCrossRef
13.
Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012PubMedCrossRef
14.
15.
Hedges LV, Tipton E, Johnson MC (2010) Robust variance estimation in meta-regression with dependent effect size estimates. Res Synth Meth 1:39–65CrossRef
16.
Cochran WG (1954) The combination of estimates from different experiments. Biometrics 10:101–129CrossRef
17.
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRef
18.
Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (March 2011). In: Higgins JPT, Green S (eds) The Cochrane Collaboration, 2011
19.
Hardy RJ, Thompson SG (1998) Detecting and describing heterogeneity in meta-analysis. Stat Med 17:841–856PubMedCrossRef
20.
Poole C, Greenland S (1999) Random-effects meta-analyses are not always conservative. Am J Epidemiol 150:469–475PubMedCrossRef
21.
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRef
22.
Belfort MB, Gillman MW, McCormick MC (2012) Prenatal and perinatal predictors of blood pressure at school age in former preterm, low birth weight infants. J Perinatol 32:265–269PubMedCrossRef
23.
Nelson RG, Morgenstern H, Bennett PH (1998) Intrauterine diabetes exposure and the risk of renal disease in diabetic Pima Indians. Diabetes 47:1489–1493PubMedCrossRef
24.
Boney CM, Verma A, Tucker R, Vohr BR (2005) Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115:e290–e296PubMedCrossRef
25.
Buzinaro EF, Berchieri CB, Haddad AL, Padovani CR, Pimenta Wde P (2008) Overweight in adolescent offspring of women with hyperglycemia during pregnancy. Arq Bras Endocrinol Metabol 52:85–92PubMedCrossRef
26.
Calabrese S, Giansante C, Burigana F, Feruglio FS (1981) Platelet factor 3 and 4 in juvenile diabetes and in children of diabetic mothers. Minerva Med 72:2255–2260PubMed
27.
Charles MA, Pettitt DJ, Hanson RL et al (1994) Familial and metabolic factors related to blood pressure in Pima Indian children. Am J Epidemiol 140:123–131PubMed
28.
Cho NH, Silverman BL, Rizzo TA, Metzger BE (2000) Correlations between the intrauterine metabolic environment and blood pressure in adolescent offspring of diabetic mothers. J Pediatr 136:587CrossRef
29.
Krishnaveni GV, Veena SR, Hill JC, Kehoe S, Karat SC, Fall CH (2010) Intrauterine exposure to maternal diabetes is associated with higher adiposity and insulin resistance and clustering of cardiovascular risk markers in Indian children. Diabetes Care 33:402–404PubMedCrossRef
30.
Kvehaugen AS, Andersen LF, Staff AC (2010) Anthropometry and cardiovascular risk factors in women and offspring after pregnancies complicated by preeclampsia or diabetes mellitus. Acta Obstet Gynecol Scand 89:1478–1485PubMedCrossRef
31.
Lee H, Jang HC, Park HK, Cho NH (2007) Early manifestation of cardiovascular disease risk factors in offspring of mothers with previous history of gestational diabetes mellitus. Diabetes Res Clin Pract 78:238–245PubMedCrossRef
32.
Manderson JG, Mullan B, Patterson CC, Hadden DR, Traub AI, McCance DR (2002) Cardiovascular and metabolic abnormalities in the offspring of diabetic pregnancy. Diabetologia 45:991–996PubMedCrossRef
33.
Rijpert M, Evers IM, de Valk HW et al (2011) Cardiovascular and metabolic outcome in 6–8 year old offspring of women with type 1 diabetes with near-optimal glycaemic control during pregnancy. Early Hum Dev 87:49–54PubMedCrossRef
34.
Tam WH, Ma RC, Yang X et al (2008) Glucose intolerance and cardiometabolic risk in children exposed to maternal gestational diabetes mellitus in utero. Pediatrics 122:1229–1234PubMedCrossRef
35.
Tam WH, Ma RC, Yang X et al (2010) Glucose intolerance and cardiometabolic risk in adolescents exposed to maternal gestational diabetes: a 15-year follow-up study. Diabetes Care 33:1382–1384PubMedCrossRef
36.
Tsadok MA, Friedlander Y, Paltiel O et al (2011) Obesity and blood pressure in 17-year-old offspring of mothers with gestational diabetes: insights from the Jerusalem Perinatal Study. Exp Diabetes Res 2011:906154PubMed
37.
Vohr BR, McGarvey ST, Tucker R (1999) Effects of maternal gestational diabetes on offspring adiposity at 4–7 years of age. Diabetes Care 22:1284–1291PubMedCrossRef
38.
West NA, Crume TL, Maligie MA, Dabelea D (2011) Cardiovascular risk factors in children exposed to maternal diabetes in utero. Diabetologia 54:504–507PubMedCrossRef
39.
Wright CS, Rifas-Shiman SL, Rich-Edwards JW, Taveras EM, Gillman MW, Oken E (2009) Intrauterine exposure to gestational diabetes, child adiposity, and blood pressure. Am J Hypertens 22:215–220PubMedCrossRef
40.
Catalano PM, Farrell K, Thomas A et al (2009) Perinatal risk factors for childhood obesity and metabolic dysregulation. Am J Clin Nutr 90:1303–1313PubMedCrossRef
41.
Lindsay RS, Nelson SM, Walker JD et al (2010) Programming of adiposity in offspring of mothers with type 1 diabetes at age 7 years. Diabetes Care 33:1080–1085PubMedCrossRef
42.
Pirkola J, Vaarasmaki M, Leinonen E et al (2008) Maternal type 1 and gestational diabetes: postnatal differences in insulin secretion in offspring at preschool age. Pediatr Diabetes 9:583–589PubMedCrossRef
43.
Karcaaltincaba D, Kandemir O, Yalvac S, Guvendag-Guven S, Haberal A (2009) Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria. Int J Gynaecol Obstet 106:246–249PubMedCrossRef
44.
Hillier T, Pedula K, Schmidt M, Mullen J, Charles M-A, Pettitt D (2007) Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 30:2287PubMedCrossRef
45.
Metzger BE, Lowe LP, Dyer AR et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358:1991–2002PubMedCrossRef
46.
Dabelea D (2007) The predisposition to obesity and diabetes in offspring of diabetic mothers. Diabetes Care 30(Suppl 2):S169–S174PubMedCrossRef
47.
Silverman BLMBE, Cho NH, Loeb CA (1995) Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes care 18:611–617PubMedCrossRef
48.
Dubey RK, Oparil S, Imthurn B, Jackson EK (2002) Sex hormones and hypertension. Cardiovasc Res 53:688–708PubMedCrossRef
49.
50.
Mente A, Yusuf S, Islam S et al (2010) Metabolic syndrome and risk of acute myocardial infarction a case–control study of 26,903 subjects from 52 countries. J Am Coll Cardiol 55:2390–2398PubMedCrossRef
51.
Dunne FP, Barry DG, Ferriss JB, Grealy G, Murphy D (1991) Changes in blood pressure during the normal menstrual cycle. Clin Sci (Lond) 81:515–518
52.
He Q, Ding ZY, Fong DYT, Karlberg J (2000) Blood pressure is associated with body mass index in both normal and obese children. Hypertension 36:165–170PubMedCrossRef
53.
Brenner BM, Garcia DL, Anderson S (1988) Glomeruli and blood pressure. Less of one, more the other? Am J Hypertens 1:335–347PubMed
54.
Ritz E, Amann K, Koleganova N, Benz K (2011) Prenatal programming-effects on blood pressure and renal function. Nat Rev Nephrol 7:137–144PubMedCrossRef
55.
Keller G, Zimmer G, Mall G, Ritz E, Amann K (2003) Nephron number in patients with primary hypertension. N Engl J Med 348:101–108PubMedCrossRef
56.
Amri K, Freund N, Vilar J, Merlet-Benichou C, Lelievre-Pegorier M (1999) Adverse effects of hyperglycemia on kidney development in rats: in vivo and in vitro studies. Diabetes 48:2240–2245PubMedCrossRef
57.
Pinter E, Haigh J, Nagy A, Madri JA (2001) Hyperglycemia-induced vasculopathy in the murine conceptus is mediated via reductions of VEGF-A expression and VEGF receptor activation. Am J Pathol 158:1199–1206PubMedCrossRef
58.
Tam WH, Ma RC, Yip GW et al (2012) The association between in utero hyperinsulinemia and adolescent arterial stiffness. Diabetes Res Clin Pract 95:169–175PubMedCrossRef
59.
Franklin SS (2008) Beyond blood pressure: arterial stiffness as a new biomarker of cardiovascular disease. J Am Soc Hypertens 2:140–151PubMedCrossRef
60.
Dabelea D, Hanson RL, Lindsay RS et al (2000) Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes 49:2208–2211PubMedCrossRef
61.
Philipps LH, Santhakumaran S, Gale C et al (2011) The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis. Diabetologia 54:1957–1966PubMedCrossRef
62.
Robins JM, Greenland S (1992) Identifiability and exchangeability for direct and indirect effects. Epidemiology 3:143–155PubMedCrossRef
63.
Walker E, Hernandez AV, Kattan MW (2008) Meta-analysis: its strengths and limitations. Cleve Clin J Med 75:431–439PubMedCrossRef
64.
Graves JW, Althaf MM (2006) Utility of ambulatory blood pressure monitoring in children and adolescents. Pediatr Nephrol 21:1640–1652PubMedCrossRef
65.
Sun SS, Grave GD, Siervogel RM, Pickoff AA, Arslanian SS, Daniels SR (2007) Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics 119:237–246PubMedCrossRef
66.
Roger VL, Go AS, Lloyd-Jones DM et al (2012) Heart disease and stroke statistics – 2012 update: a report from the American Heart Association. Circulation 125:e2–e220PubMedCrossRef
67.
Kannel WB, Vasan RS, Levy D (2003) Is the relation of systolic blood pressure to risk of cardiovascular disease continuous and graded, or are there critical values? Hypertension 42:453–456PubMedCrossRef
68.
69.
Catalano PM, Thomas A, Huston-Presley L, Amini SB (2003) Increased fetal adiposity: a very sensitive marker of abnormal in utero development. Am J Obstet Gynecol 189:1698–1704PubMedCrossRef
Metadata
Title
The diabetic pregnancy and offspring blood pressure in childhood: a systematic review and meta-analysis
Authors
A. Aceti
S. Santhakumaran
K. M. Logan
L. H. Philipps
E. Prior
C. Gale
M. J. Hyde
N. Modi
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 11/2012
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-012-2689-8

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