Mild Gestational Diabetes Mellitus and Long-Term Child Health

Abstract

OBJECTIVETo evaluate whether treatment of mild gestational diabetes mellitus (GDM) confers sustained offspring health benefits, including a lower frequency of obesity.RESEARCH DESIGN AND METHODSFollow-up study of children (ages 5–10) of women enrolled in a multicenter trial of treatment versus no treatment of mild GDM. Height, weight, blood pressure, waist circumference, fasting glucose, fasting insulin, triglycerides, and HDL cholesterol were measured.RESULTSFive hundred of 905 eligible offspring (55%) were enrolled. Maternal baseline characteristics were similar between the follow-up treated and untreated groups. The frequencies of BMI ≥95th (20.8% and 22.9%) and 85th (32.6% and 38.6%) percentiles were not significantly different in treated versus untreated offspring (P = 0.69 and P = 0.26). No associations were observed for BMI z score, log waist circumference, log triglycerides, HDL cholesterol, blood pressure, or log HOMA-estimated insulin resistance (HOMA-IR). The effect of treatment was different by sex for fasting glucose and log HOMA-IR (P for interaction = 0.002 and 0.02, respectively) but not by age-group (5–6 and 7–10 years) for any outcomes. Female offspring of treated women had significantly lower fasting glucose levels.CONCLUSIONSAlthough treatment for mild GDM has been associated with neonatal benefits, no reduction in childhood obesity or metabolic dysfunction in the offspring of treated women was found. However, only female offspring of women treated for mild GDM had lower fasting glucose.

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

“…Thus, the findings here align with previous results showing a high risk of macrosomia and later obesity among children born of mothers with gestational diabetes. 28,29 We further show that infants of mothers with diabetes are markedly larger during the first 24 months. Continued research is needed in other cohorts to verify the findings here given that others have shown that whereas children of mothers with diabetes are heavier, these patterns are not observed during infancy.…”

Placental lipoprotein lipase DNA methylation alterations are associated with gestational diabetes and body composition at 5 years of age

“…41 This metabolic dysfunction could be induced by a prenatal exposure to intrauterine insults during critical periods of epigenetic programming, which could increase the risk for cardiovascular complications later in life. 21,22,43 Although our study added evidence supporting the implication of epigenetic modifications in the fetal metabolic programming of weight at birth and in mid-childhood, the impact on later life health and diseases, such as lipid metabolism impairments (according to the DOHaD hypothesis), needs to be studied. Nonetheless, it has been shown that metabolic dysfunctions later in life are predicted by birth weight and growth in childhood, for which placental LPL DNAm deregulation might be one of the underlying mechanisms.…”

“…[20][21][22] Mothers from our cohort were carefully followed up, and those with GDM were treated in accordance with established clinical practices. Accordingly, GDM mothers gained significantly less weight in the last trimester of pregnancy as compared with NGT mothers, suggesting that they were compliant to treatment.…”

Is it worth treating gestational diabetes: if so, when and how?

“…In one follow-up study, maternal depression rates 3 months after delivery were lower in the intervention group than in the group of mothers who received usual care [15]. Though the intensive treatment of mothers with GDM was associated with a significant decrease in birthweight and macrosomia, it was not found to result in a change in the child's BMI at age 4-5 [20] or in a reduction of childhood obesity or metabolic dysfunction at age 5-10 [21] in the follow-ups of the previously mentioned studies. Hence, longer follow-up studies are merited.…”