Intrauterine Exposure to Maternal Diabetes Is Associated With Higher Adiposity and Insulin Resistance and Clustering of Cardiovascular Risk Markers in Indian Children

Abstract

OBJECTIVETo test the hypothesis that maternal gestational diabetes increases cardiovascular risk markers in Indian children.RESEARCH DESIGN AND METHODSAnthropometry, blood pressure, and glucose/insulin concentrations were measured in 514 children at 5 and 9.5 years of age (35 offspring of diabetic mothers [ODMs], 39 offspring of diabetic fathers [ODFs]). Children of nondiabetic parents were control subjects.RESULTSAt age 9.5 years, female ODMs had larger skinfolds (P < 0.001), higher glucose (30 min) and insulin concentrations, and higher homeostasis model assessment (HOMA) of insulin resistance and systolic blood pressure (P < 0.05) than control subjects. Male ODMs had higher HOMA (P < 0.01). Associations were stronger than at age 5 years. Female ODFs had larger skinfolds and male ODFs had higher HOMA (P < 0.05) than control subjects; associations were weaker than for ODMs. Associations between outcomes in control subjects and parental BMI, glucose, and insulin concentrations were similar for mothers and fathers.CONCLUSIONSThe intrauterine environment experienced by ODMs increases diabetes and cardiovascular risk over genetic factors; the effects strengthen during childhood.

The diabetic pregnancy and offspring blood pressure in childhood: a systematic review and meta-analysis

“…This may be due to the variable definition used across studies (Table 1), which can impact on the reported population prevalence of GDM [43]. Three studies define GDM using the Carpenter and Coustan diagnostic criteria (lower threshold than the National Diabetes Data Group) [24,29,39]; all found greater systolic BP in ODM. Inclusion of studies using lower threshold criteria for GDM diagnosis may affect the magnitude of the effect seen, but long-term effects probably occur across the range of maternal glucose intolerance [44].…”

“…The literature search identified 94 papers, of which 19 matched the inclusion criteria [11,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (Fig. 1).…”

“…Seven studies provided BP in offspring of mothers with GDM [24,25,29,34,36,39,40], and two in offspring of mothers with type 1 diabetes [32,33]. Four studies included pooled outcome data for offspring of both type 1 diabetes and GDM mothers [28,30,38,42]; one study included data from prepregnancy type 2 diabetes in their pooled diabetic group [28]; authors provided separate data for type 1 diabetes and GDM for three studies [30,38,42].…”

“…One study provided sex-specific data for offspring BP [29]; authors of all included studies were contacted, and sexspecific data were provided for eight further studies [24,30,33,34,36,38,40,42]. Five studies reported maternal prepregnancy BMI [25,30,36,39,40], and two studies reported offspring SBP data adjusted for prepregnancy maternal BMI [38,39].…”

“…Study quality A meta-analysis limited to studies scoring ≥5 out of 7 according to the Modified Newcastle-Ottawa Quality Assessment Scale (seven studies for SBP [24,29,30,33,34,36,39], six studies for DBP [24,29,30,33,34,36] Adjusted analyses In five studies, SBP was adjusted for covariates including offspring sex and age [33,34,36,38,39]. A meta-analysis of the adjusted data showed that SBP was higher in ODM than controls (2.43 mmHg [95% CI 0.90, 3.97]; p00.002; random-effects analysis; ESM Fig.…”