Prevalence and Predictors of Overweight and Insulin Resistance in Offspring of Mothers With Gestational Diabetes Mellitus

Abstract

OBJECTIVEGestational diabetes mellitus (GDM) is associated with high birth weight in the offspring. This may lead to overweight and insulin resistance during childhood. The aim of the study was to assess the impact of GDM on overweight risk and insulin resistance in offspring.RESEARCH DESIGN AND METHODSBMI measurements were collected at age 2, 8, and 11 years from 232 offspring of mothers with GDM (OGDM) and compared with those from 757 offspring of mothers with type 1 diabetes (OT1D) and 431 offspring of nondiabetic mothers (ONDM) born between 1989 and 2000. Insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR]) was determined at age 8 and 11 years in 751 children (74 OGDM). Overweight was defined as BMI percentile ≥90; insulin resistance was defined by HOMA-IR.RESULTSOverweight prevalence was increased in OGDM compared with OT1D and to ONDM throughout childhood (age 11 years 31.1, 15.8, and 15.5%; P = 0.005). Maternal obesity was an important predictor of overweight risk in children (age 11 years odds ratio 7.0 [95% CI 1.8–27.7]; P = 0.006); birth size and maternal smoking during pregnancy were inconsistently associated with and treatment of GDM during pregnancy did not affect overweight risk. HOMA-IR was increased in OGDM compared with offspring of ONDM mothers (P = 0.01, adjusted for sex and age) and was associated with the child's BMI (P = 0.004).CONCLUSIONSOverweight and insulin resistance in children is increased in OGDM compared with OT1D or ONDM. The finding that overweight risk is associated mainly with maternal obesity suggests that familial predisposition contributes to childhood growth in these offspring.

A two-step screening algorithm including fasting plasma glucose measurement and a risk estimation model is an accurate strategy for detecting gestational diabetes mellitus

“…Furthermore, Black et al recently demonstrated that the risk for adverse pregnancy outcomes differs between women with impaired fasting glucose and abnormal glucose values during the OGTT, providing evidence that women with elevated fasting levels particularly suffer from delivering LGA infants [28]. Our results might corroborate this important observation as the presented risk algorithm, which uses a maximum of information from the FPG measurement, was strongly associated with postnatal macrosomia, even when the model was adjusted for other OGTT values and moreover for GDM status as well as other variables associated with macrosomia of the offspring, such as preconception BMI [29] or maternal triacylglycerol levels [30,31].…”

High-fat diet alters the dopamine and opioid systems: effects across development

“…18,19 Diabetes in pregnancy also increases the risk for obesity in childhood 20 and in young adults, 21 although maternal obesity may be a stronger determinant than diabetes status, per se. 22,23 There is support in the literature for LGA increasing the risk for adverse neurobehavioral outcomes, such as autism spectrum disorders, 24,25 increased anxiety/depression, 26 difficulty with emotional regulation 27 and an increased risk for attention deficit hyperactivity disorder. 27--29 Attention deficits have also been observed in offspring born to mothers with diabetes before or during pregnancy.…”

Differences in breast-feeding initiation and continuation by maternal diabetes status

“…Maternal diabetes in pregnancy may cause 'metabolic imprinting' and result in metabolic dysregulation in infants (7) , increasing the risk of the development of neonatal hypoglycaemia in early life and type 2 diabetes, obesity and metabolic syndrome later in life (8)(9)(10)(11)(12) . Diabetes in pregnancy increases the risk of premature birth, as well as increases the risk for infant morbidity and mortality (13,14) .…”