Associations of Gestational Diabetes, Existing Diabetes, and Glycosuria With Offspring Obesity and Cardiometabolic Outcomes

Abstract

OBJECTIVEdTo assess associations of gestational diabetes, existing diabetes, and glycosuria with adiposity and cardiometabolic risk factors in offspring at adolescence.RESEARCH DESIGN AND METHODSdMultivariable regression analyses were conducted in a prospective pregnancy cohort (n = 2,563-4,198 for different outcomes). Obstetric data were abstracted from clinical records. Offspring outcomes were assessed at mean age 15.5 years. Compared with those lost to follow-up, participants included in the analysis were of higher socioeconomic position. Outcomes included BMI, waist circumference, fat mass determined by dual-energy X-ray absorptiometry scan, systolic and diastolic blood pressure (sBP and dBP, respectively), fasting glucose, insulin, lipids, and C-reactive protein (CRP).RESULTSdMaternal existing diabetes, gestational diabetes, and glycosuria were associated with higher offspring BMI and fat mass (z scores); however, this effect was attenuated in the confounder-adjusted model, and the CIs included the null value. Existing diabetes and gestational diabetes were associated with higher offspring fasting glucose levels ( CONCLUSIONSdMaternal pregnancy glycosuria, gestational diabetes, and existing diabetes show some associations with higher offspring fasting glucose and insulin assessed in adolescence but are not clearly associated with a wider range of cardiometabolic risk factors. 35:63-71, 2012 D etailed analyses from Pima Indian populations have demonstrated that fetal exposure to maternal diabetes in utero increases the risk of obesity and type 2 diabetes for offspring in later life (1). Fewer studies examine these associations in non-Pima populations, in whom the prevalence of obesity and diabetes is much lower. A recent systematic review and meta-analysis identifies nine such studies and concludes that maternal diabetes is associated with increased offspring BMI (2). The authors highlighted that only three of the nine studies had adjusted for maternal prepregnancy or early pregnancy BMI and that pooling results from these studies after adjustment for maternal BMI suggested that this was a major confounder for the association with offspring BMI. However, there was evidence of marked heterogeneity between results from these three studies, potentially reflecting the different underlying types of diabetes examined and the prepubertal ages examined (2). Furthermore, the review does not include a recently published very large sibling study in Swedish men that similar to studies in the Pima, supports an intrauterine mechanism linking maternal diabetes in pregnancy with offspring BMI that is not confounded by maternal early pregnancy BMI (3). In that study, mean BMI at age 18 years of younger brothers born after their mother was diagnosed with diabetes in pregnancy was greater than their older brothers' mean BMI who were born before this diagnosis (3). It is notable that to date, few studies have examined associations with other offspring cardiometabolic risk factors and whether associations are mediated by the ...

Childhood Cardiometabolic Outcomes of Maternal Obesity During Pregnancy

“…The observed effects were also not mediated by pregnancy complications, birth characteristics, or infant growth, which are all identified risk factors related to both maternal prepregnancy BMI and health of offspring. [38][39][40][41] Thus, our findings suggest that associations of maternal prepregnancy BMI with offspring cardiometabolic health outcomes may, at least partly, be explained by direct intrauterine mechanisms. This may include higher maternal plasma concentrations and placental transfer of glucose, amino acids, and free fatty acids during pregnancy, which may influence programming of offspring adiposity and an adverse cardiometabolic profile in later life.…”

Maternal gestational diabetes and childhood obesity at age 9–11: results of a multinational study

“…In the Northwestern University Diabetes in Pregnancy Study, diabetes during pregnancy, including both GDM and insulin-treated diabetes prior to pregnancy, was associated with increased BMI of the offspring at birth and after 5 years of age [27]. However, other studies failed to find a clear association between maternal GDM and obesity in children aged 5 years or older [7–11]. One study found that prenatal exposure to the metabolic effects of mild, diet-treated GDM did not increase the risk of childhood obesity [7].…”

Effect of Maternal Cardiovascular Conditions and Risk Factors on Offspring Cardiovascular Disease

“…26 Evidence for an association between maternal diabetes and offspring BP, lipids, or CRP was also weak. 89 Finally, another recent study reported that maternal diabetes increased offspring BMI by in utero mechanisms independent of maternal BMI, and suggested that offspring adiposity may be responsible for their higher BP. 44, 90 …”