Programming of Adiposity in Offspring of Mothers With Type 1 Diabetes at Age 7 Years

Abstract

OBJECTIVEThe goals of this study were to examine the influence of maternal type 1 diabetes during pregnancy on offspring adiposity and glucose tolerance at age 7 years and to assess whether metabolic factors at birth (neonatal leptin and insulin) predict adverse outcomes.RESEARCH DESIGN AND METHODSWe examined 100 offspring of mothers with type 1 diabetes (OT1DM) and 45 offspring of control mothers. Mothers had previously been recruited during pregnancy, and, where possible, birth weight, umbilical cord insulin, and leptin were measured. Children were classed as overweight and obese using age-specific reference ranges.RESULTSOT1DM had similar height (control, 1.25 ± 0. 06 m; OT1DM, 1.24 ± 0.06 m; P = 0.81) but were heavier (control, 25.5 ± 3.8 kg; OT1DM, 27.1 ± 5.7 kg; P = 0.048) and had an increased BMI (control, 16.4 kg/m2; OT1DM, 17.4 ± 2.6 kg/m2, P = 0.005). Waist circumference (control, 56.0 ± 3.7 cm; OT1DM, 58 ± 6.8 cm; P = 0.02) and sum of skinfolds were increased (control, 37.5 ± 17.0 mm [n = 42]; OT1DM, 46.1 ± 24.2 mm [n = 91]; P = 0.02), and there was a marked increase in the prevalence of overweight and obese children (OT1DM, 22% overweight and 12% obese; control, 0% overweight and 7% obese; χ2 P = 0.001). Glucose tolerance was not different compared with that in control subjects. BMI at age 7 years correlated with cord leptin (OT1DM, r = 0.25; n = 61, P = 0.047), weakly with adjusted birth weight (r = 0.19; P = 0.06) and hematocrit (r = 0.25; n = 50, P = 0.07), but not cord insulin (OT1DM, r = −0.08; P = 0.54).CONCLUSIONSOT1DM are at increased risk of overweight and obesity in childhood. This risk appears to relate, in part, to fetal leptin and hematocrit but not insulin.

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

“…Two additional studies were identified through a search of forward citations [15,48] and four [49][50][51][52] from hand-searching the reference lists of included papers, giving 34 papers in total. Five cohorts were reported in more than one paper, so only the study that reported the outcomes at an age closest to the overall median age of all studies (7 years) was included in the meta-analysis; 10 papers were excluded on this basis [25, 35, 36, 38-40, 42, 47-49].…”

“…Included studies n=9 Three studies adjust for covariates including maternal prepregnancy BMI [15,27,46]. A meta-analysis of the raw BMI z score data from these three studies shows increased BMI in the offspring of diabetic mothers (0.23 [95% CI 0.06, 0.40]; p=0.009; I 2 =20%, p=0.29).…”

“…Given the increased risk of developing type 2 diabetes in later life in children born to mothers with diabetes [5], it is plausible that this might be mediated through an increase in offspring BMI. However, to date individual studies examining BMI in offspring of diabetic mothers (ODM) have been small with limited power and contradictory results [13][14][15].…”

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

“…Two papers mentioned BP, but reported no data [26,41]; the authors were contacted, but were unable to provide the data. Where outcome data were not represented as unadjusted mean and SD [24,30,33,34,36,38,42], the authors were contacted; data were received for all studies.…”

“…1). Three additional studies [40][41][42] were identified from the reference lists of included papers, giving 22 papers in total. Two cohorts were reported twice; two papers were excluded on this basis [35,37].…”