title: Multisystem Morbidity and Mortality in Offspring of Women With Type 1 Diabetes (the EPICOM Study): A Register-Based Prospective Cohort Study.
abstract: OBJECTIVE
  This 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 HbA1c levels during pregnancy and mortality and incidence of hospital admissions.
  
  
  METHODS
  We 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 HbA1c levels during pregnancy and mortality and the incidence of hospital admissions. Participants were monitored from birth to the age of 13-21 years.
  
  
  RESULTS
  Overall 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 HbA1c 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).
  
  
  CONCLUSIONS
  Type 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.
authors.affiliation: Department of Endocrinology and Internal Medicine and Department of Molecular Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Sine
authors.initials: S
authors.lastname: Knorr
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Kirstine
authors.initials: K
authors.lastname: Stochholm
authors.affiliation: Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Vlachová
authors.affiliation: Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Bytoft
authors.affiliation: Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
authors.forename: Tine D
authors.initials: TD
authors.lastname: Clausen
authors.affiliation: Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Rikke Beck
authors.initials: RB
authors.lastname: Jensen
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Svend
authors.initials: S
authors.lastname: Juul
authors.affiliation: Department of Gynaecology and Obstetrics, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Ovesen
authors.affiliation: Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Damm
authors.affiliation: Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Beck-Nielsen
authors.affiliation: Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Dorte M
authors.initials: DM
authors.lastname: Jensen
authors.affiliation: Department of Endocrinology and Internal Medicine and Department of Molecular Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ch.gravholt@dadlnet.dk.
authors.forename: Claus Højbjerg
authors.initials: CH
authors.lastname: Gravholt
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D009035:Mothers; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000401:mortality*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin