Multisystem Morbidity and Mortality in Offspring of Women With Type 1 Diabetes (the EPICOM Study): A Register-Based Prospective Cohort Study

Abstract

OBJECTIVEThis study examined the long-term consequences for offspring born to mothers with pregestational type 1 diabetes regarding mortality, hospital admissions, and medication. We also examined the association between HbA 1c levels during pregnancy and mortality and incidence of hospital admissions. RESEARCH DESIGN AND METHODSWe performed a prospective combined clinical and register-based cohort study comparing mortality, hospital admissions, and use of medication in offspring (n = 1,326) of women with pregestational type 1 diabetes (index children) with matched control subjects (n = 131,884). We also examined the association between HbA 1c levels during pregnancy and mortality and the incidence of hospital admissions. Participants were monitored from birth to the age of 13-21 years. RESULTSOverall mortality was significantly increased for index children (hazard ratio 2.10, 95% CI 1.33-3.30, P = 0.001). The incidence of hospital admissions for index children was significantly increased (incidence rate ratio [IRR] 1.45, 95% CI 1.38-1.53, P < 0.001), and this was the case for all age groups until the age of 15 years. The incidence of hospital admissions among index children was positively associated with maternal HbA 1c before pregnancy and in the first trimester. In addition, the overall use of medication was increased in index children (IRR 1.13, 95% CI 1.07-1.19, P < 0.001). CONCLUSIONSType 1 diabetes during pregnancy has long-term implications on the health of offspring, with increased mortality, incidence of hospital admissions, and use of medication. Among mothers with type 1 diabetes, glycemic regulation is positively associated with incidence of hospital admissions in offspring.Women with type 1 diabetes have an increased risk of adverse pregnancy outcome, including stillbirth, perinatal mortality, and congenital malformations (1-4). However, studies concerning long-term offspring outcome are sparse and results conflicting. Some studies have demonstrated an increased risk of type 2 diabetes and obesity, whereas others have found no association with BMI, glucose, insulin, or

Mortality and morbidity in offspring of mothers with diabetes compared with a population group: a Danish cohort study with 8–35 years of follow‐up

“…The number of pregnancies in women with Type 2 diabetes was too small to allow separate analyses in this subgroup, but as their percentage of days spent in hospital is closely comparable to the findings in offspring of women with gestational diabetes, we find it relevant to analyse these two groups together. Knorr et al [11] reported an overall mortality of 1.51%, which is very close to our figure of 1.45%. Restriction of our analyses to offspring of mothers with Type 1 diabetes with an observational time of up to 21 years as in the study by Knorr et al, did not change our mortality results.…”

“…Knorr et al . reported an overall mortality of 1.51%, which is very close to our figure of 1.45%. Restriction of our analyses to offspring of mothers with Type 1 diabetes with an observational time of up to 21 years as in the study by Knorr et al ., did not change our mortality results.…”

“…The outcomes, however, were restricted to hospital admissions for these specific categories of diseases and did not address overall hospitalization. Recently, a Danish group has reported significantly higher incidence of both mortality and morbidity in terms of number of admissions to hospital and use of prescribed drugs in offspring of mothers with diabetes compared with offspring of mothers without diabetes .…”

Long-term Cognitive Implications of Intrauterine Hyperglycemia in Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study)

“…Intrauterine hyperglycemia has both short-term and long-term implications on offspring morbidity and mortality, which are associated with the degree of maternal glycemic control before and during pregnancy (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

Impact of type 1 diabetes on maternal long-term risk of hospitalisation and mortality: a nationwide combined clinical and register-based cohort study (The EPICOM study)

“…NCT01559181). Information concerning the children of these mothers and details about the study has previously been published [21].…”