435: Gestational diabetes mellitus as an independant risk factor for long-term pediatric cardiovascular morbidity of the offspring

Objective
To assess whether in utero exposure to gestational diabetes mellitus (GDM) increases the risk for long-term cardiovascular morbidity of the offspring.
Study Design
A retrospective population-based cohort study compared long-term (up to the age of 18 years) hospitalized pediatric cardiovascular morbidity between singletons prenatally exposed and unexposed to GDM. Deliveries occurred between the years 1991-2014 in a regional tertiary medical center. The exposure variables were diet-controlled GDM (GDMA1) and treated GDM (GDMA2). Mothers with pre-gestational diabetes mellitus and infants with congenital malformations were excluded from the study. A multivariable generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters.

Results
During the study period 256,270 deliveries met the inclusion criteria, of which 5.0% were diagnosed with GDM (n=12,889). During the follow-up period, children exposed in utero to GDM had a higher rate of long- term cardiovascular morbidity compared to those unexposed (Table; rates of hospitalizations with cardiovascular morbidity, by in-utero exposure to GDM). Using a multivariable GEE logistic regression model, controlling for maternal age, gestational age at delivery, birthweight and the time to event; in utero exposure to GDMA1 (adjusted OR =1.5; 95% CI 1.1-2.3; P=0.024) and especially to GDMA2 (adjusted OR =3.1; 95% CI 1.8-5.1, P<0.001) were found as independent risk factors for long-term cardiovascular disease during childhood.
Conclusion
Exposure to maternal GDM is an independent risk factor for long-term cardiovascular morbidity of the offspring.