Effect of Treatment of Gestational Diabetes Mellitus on Obesity in the Next Generation

Abstract

OBJECTIVEGestational diabetes mellitus (GDM) may cause obesity in the offspring. The objective was to assess the effect of treatment for mild GDM on the BMI of 4- to 5-year-old children.RESEARCH DESIGN AND METHODSParticipants were 199 mothers who participated in a randomized controlled trial of the treatment of mild GDM during pregnancy and their children. Trained nurses measured the height and weight of the children at preschool visits in a state-wide surveillance program in the state of South Australia. The main outcome measure was age- and sex-specific BMI Z score based on standards of the International Obesity Task Force.RESULTSAt birth, prevalence of macrosomia (birth weight ≥4,000 g) was 5.3% among the 94 children whose mothers were in the intervention group, and 21.9% among the 105 children in the routine care control group. At 4- to 5-years-old, mean (SD) BMI Z score was 0.49 (1.20) in intervention children and 0.41 (1.40) among controls. The difference between treatment groups was 0.08 (95% CI −0.29 to 0.44), an estimate minimally changed by adjustment for maternal race, parity, age, and socio-economic index (0.08 [−0.29 to 0.45]). Evaluating BMI ≥85th percentile rather than continuous BMI Z score gave similarly null results.CONCLUSIONSAlthough treatment of GDM substantially reduced macrosomia at birth, it did not result in a change in BMI at age 4- to 5-years-old.

Association between Prepregnancy Body Mass Index and Gestational Weight Gain with Size, Tempo, and Velocity of Infant Growth: Analysis of the Newborn Epigenetic Study Cohort

“…31 Yet, with some exceptions, there are few early life cycle studies that aim to address early childhood obesity by intervening during the prenatal phases of development. 32 Observational studies that follow children born of mothers who were participants in lifestyle interventions targeting gestational weight gain or gestational diabetes have not found a ''spillover'' effect on childhood obesity or metabolic profile. [32][33][34] Grounding interventions in life course theoretical models and developing solution-focused intervention strategies that cover both prenatal and early postnatal behavioral changes may be needed to advance the evidence base in this area.…”

Bagaimana Gizi Sejak Massa Konsepsi Dapat Mempengaruhi Kesehatan Biologis Anak?

“…Therefore, a real outcome might be less than optimal outcome we might want, that is some of the children from mothers who implement the lifestyle recommendation would be overweight or obese and having hypertension at the age of 10. The results of an RCT targeting women with mild GDM between 24-34 weeks gestation with predominantly dietary interventions and blood glucose monitoring fail to show significant difference in BMI of the children at age 4 to 5 years old 10 . Upon this null effect size, the author argues that they can not adjust the results for possibility the effect of post natal factor that determine the height and weight of the child for example the food eaten and physical exercise, overpower the effect of treating GDM during pregnancy 10 .…”

“…The results of an RCT targeting women with mild GDM between 24-34 weeks gestation with predominantly dietary interventions and blood glucose monitoring fail to show significant difference in BMI of the children at age 4 to 5 years old 10 . Upon this null effect size, the author argues that they can not adjust the results for possibility the effect of post natal factor that determine the height and weight of the child for example the food eaten and physical exercise, overpower the effect of treating GDM during pregnancy 10 . Furthermore the authors argue that the effect of fetal origin of disease might be takes more time to occurs by citing the finding from Pima Indian study that showed association of maternal GDM with the offspring BMI after the age of 9, but not before 10 .…”

“…Upon this null effect size, the author argues that they can not adjust the results for possibility the effect of post natal factor that determine the height and weight of the child for example the food eaten and physical exercise, overpower the effect of treating GDM during pregnancy 10 . Furthermore the authors argue that the effect of fetal origin of disease might be takes more time to occurs by citing the finding from Pima Indian study that showed association of maternal GDM with the offspring BMI after the age of 9, but not before 10 . We believe that many factors, especially external factors such as the role of obesogenic environments 14,15 , child physical activity 16 and caloric dense diet 17 of the child post-natal until the age of 10 might be deviate our optimal results.…”

“…In animal study, induced GDM was lead to adiposity accumulation in the offspring. When the next generation is female, she has high chance of developing GDM and when pregnant the cycle of intergenerational diabetes and obesity will be perpetuated 10 . Randomized controlled trial with intervention consisting of dietary advice, blood glucose monitoring and if deemed required, insulin therapysuccessfully reduced macrosomia at birth which considered one of the pathway where fetal origin of adult disease might take place 10 .…”