Hyperglycemia in Pregnancy Associated With Elevated Blood Pressure in Offspring

Hyperglycemia in pregnancy increases risk for elevated blood pressure in offspring.

Elevated blood pressure (BP) in offspring is associated with hyperglycemia in pregnancy, according to systematic review and meta-analysis findings published in Diabetology & Metabolic Syndrome.

Investigators sought to evaluate the potential association between hyperglycemia in pregnancy and blood pressure in offspring.

They conducted a systematic review and meta-analysis of 23 cohort studies found in PubMed, MEDLINE, and Embase from inception to February 2021. Included articles examined the effects of hyperglycemia in pregnancy on offspring’s systolic blood pressure (SBP) and diastolic blood pressure (DBP) without language or geographic restrictions. Studies that included twins were excluded. Papers without full text, randomized controlled trials, cross-sectional studies, non-in vitro studies, nonoriginal studies, and studies with incomplete data were also excluded. The literature search was conducted by 2 independent investigators. The analysis included 88,695 offspring.

There were 17 studies conducted in high-income countries (accounting for 73.9% of all participants), 3 studies in upper-middle-income countries (13.0%), and 3 studies in lower-middle-income countries (7.4%). Substantial heterogeneity was found in 8 studies published before 2010, 7 studies on patients treated with insulin, 6 studies on patients not treated with insulin, 2 studies in the European WHO region, and 3 studies in the Western Pacific WHO region (substantial heterogeneity defined as I2 >50%).

…our review indicates that GDM may result in elevated systolic and diastolic BP in the offspring, providing evidence for fetal cardiovascular risks brought by HIP.

The investigators found that the offspring of women with hyperglycemia in pregnancy had increased levels of systolic blood pressure (SBP; mean difference, 1.90 mm Hg; 95% CI, 1.09-2.70; P <.001) and increased levels of diastolic blood pressure (DBP; mean difference, 0.87 mm Hg; 95% CI, 0.11-1.17; P =.02) vs patients with normal blood glucose during pregnancy.

The investigators noted that in studies published after 2011, estimated BP in the hyperglycemia in pregnancy group was significantly higher than in controls, and there was no difference in BP in studies before 2010.

SBP in the insulin-treated group and BP in the insulin-untreated group were higher than those in the control group. The investigators found no significant difference between DBP in the insulin-treated group vs control patients.

Gestational diabetes mellitus (GDM) may have varied impacts on the BP of offspring by region and economic level of family, sex of the offspring, maternal insulin treatment status, published year, and BP measurement. Of the 5 studies that reported on BP in children born to type 1 diabetes mellitus (T1DM), investigators found no difference in SBP or DBP between offspring of women with T1DM and control patients.

Publication bias assessed by funnel plots found little effect for studies with maternal hyperglycemia in pregnancy and GDM as outcomes. There were not enough studies to use funnel plot assessment of bias for the offspring of mothers with T1DM. The investigators noted that 5 studies reported blinding of outcome assessment, 10 studies reported exposure assessed prior to outcome measurement, 8 studies reported different levels of the exposure of interest, and 12 studies reported the repeated exposure assessment, all of which were considered to potentially have high risk of bias.

Study limitations include the lack of previous data on T1DM limiting applicability of conclusions. The study also lacks data on lifestyle variables of diet, physical activities, and sleep patterns. There is also failure to demonstrate the age distribution of children relative to BP.

 “…our review indicates that GDM may result in elevated systolic and diastolic BP in the offspring, providing evidence for fetal cardiovascular risks brought by HIP [hyperglycemia in pregnancy],” the study authors wrote. “All these factors imply that changes in epigenetic mechanisms may influence the initiation and progression of metabolic diseases that warrant future research.”


Zhang X, Wang Y, Xiao W, et al. Hyperglycaemia in pregnancy and offspring blood pressure: a systematic review and meta-analysis. Diabetol Metab Syndr. Published online January 19, 2023. doi:10.1186/s13098-023-00978-2