Funding outcome

Nearly 1/3 of all deaths in the world are due to cardiovascular disease (CVD), or diseases of the heart and blood vessels typically observed in adults. While many risk factors for CVD relate to poor lifestyle choices in adulthood, it has been increasingly recognized that certain exposures while a baby is still in the womb may contribute to long- term CVD. For instance, adults whose mothers had diabetes mellitus (DM) have an increased risk of adult CVD as well as an increased risk of poor blood sugar control and DM themselves which may contribute further to CVD risk. Little is known, however, about the timing of development of CVD in infants and children of DM mothers and the factors that contribute. We have recently demonstrated that children of mothers with DM with onset before pregnancy have thickening of the heart muscle and greater stiffness of the aorta, the large artery that carries blood from the heart to the body. Greater stiffness of smaller arteries of the body is known to increase the risk of CVD in adults and contribute to increased heart wall thickness that leads to poor heart function long-term. In this earlier study we found greater aortic stiffness to be observed in children of DM mothers with higher/worse blood sugar levels only in the last part of pregnancy suggesting this may be a critical window of exposure. In the current study, we will study the heart and blood vessel health of children born to mothers who develop DM only during the later stages of pregnancy, so-called 'gestational diabetes' (GDM). GDM is far more common than DM with onset before pregnancy, complicating as many as 1 in every 7 pregnancies. Although increased blood pressure has been found in children of GDM mothers compared to chiildren of healthy mothers, no other study has examined other measures of cardiovascular health and there is little data that identify contributing factors. The heart and blood vessel health of children (ages 5-10 years) of mothers with GDM will be comprehensively assessed and compared to that of children born to healthy mothers without GDM. We will explore the contribution of maternal health during the pregnancy (e.g.blood sugar control, maternal diet during pregnancy and iron status) on the cardiovascular health of the child. We will also examine the impact of the child's own diet, physical activity levels and metabolic health (measures of obesity, blood sugar control and blood fats/cholesterol levels) on his/her own cardiovascular health. Understanding how exposure to GDM before birth contributes to longer-term alterations in cardiovascular health and the factors that negatively and positively contribute to these alterations before and after birth are key to developing strategies that improve the cardiovascular health of this large population of children life-long.