This article is more than 5 years old. Information may no longer be current.
Gestational diabetes in mothers increased childhood obesity risk in daughters
Click Here to Manage Email Alerts
Girls exposed to elevated glucose levels, particularly gestational diabetes, while in utero are at an increased risk for obesity in childhood, according to research published in Diabetes Care.
Stronger associations were observed when the mothers also were overweight or obese, researchers at Kaiser Permanente in Northern California reported.
“For mothers or mothers-to-be, lifestyle and weight can influence children’s health, so it is worth taking care of yourself before or during pregnancy,” Ai Kubo, PhD, a Kaiser epidemiologist, told Endocrine Today. “Behavior modifications in women to reduce weight gain and improve lifestyle before and during pregnancy may reduce the risk of obesity in their offspring.”
Ai Kubo
Kubo and colleagues from other institutions longitudinally evaluated associations between maternal pregnancy hyperglycemia, gestational diabetes and offspring adiposity in 421 mother-daughter pairs of varying ethnicities; 27 mothers had gestational diabetes.
The girls were part of the Cohort Study of Young Girls’ Nutrition, Environment and Transitions (CYGNET) inside the NIH consortium looking at determinants of puberty.
Maternal pregnancy glucose values were gathered from medical records. The researchers looked at three measures of girls’ adiposity, assessed annually: >85th age-specific percentile for BMI; percent body fat; and waist-to-height ratio. Adjustments were made for maternal age at delivery, race/ethnicity and pregravid BMI, as well as girls’ age and age at onset of puberty.
When mothers had gestational diabetes during pregnancy vs. the lowest blood glucose quintile, girls were more likely to have BMI >85th percentile (OR=3.56; 95% CI, 1.28-9.92), percent body fat in the highest quartile (OR=3.13; 95% CI, 1.08-9.09) or waist-to-height ratio in the highest quartile (OR=2.8; 95% CI, 1-7.84).
A significant interaction was observed between gestational diabetes and pregravid BMI; when mothers had both risk factors, girls had the highest odds of having BMI ≥85th percentile (OR=5.56; 95% CI, 1.7-18.2), percent body fat in the highest quartile (OR=6.04; 95% CI, 1.76-20.7) or waist-to-height ratio in the highest quartile (OR=3.6; 95% CI, 1.35-9.58).
Similar but weaker associations were seen between hyperglycemia and offspring adiposity.
“Overweight women who are planning on being pregnant may consider modifying lifestyle through exercise and diet to move toward optimal weight before entering pregnancy, and those who are already pregnant may want to watch their diet and exercise so they will gain optimal amount of weight during pregnancy,” Kubo said.
Disclosure: This study was supported by the National Institute of Environmental Health Sciences, the National Cancer Institute (NCI) and the National Center for Research Resources, the California Department of Public Health and Avon Foundation. Kubo reports support from NCI, NIH Office of Research on Women’s Health and National Center for Advancing Translational Sciences.
Perspective
Back to Top
Robert E. Ratner, MD, FACP, FACE
These findings are absolutely consistent with prior research that actually goes back 20 years. David Pettitt from the NIH center in Arizona looked at the offspring of women within the Pima Indian Tribe in Arizona and found precisely the same thing: diabetes and obesity in the mother carried over to obesity in the offspring — not just the daughters, but any of the offspring. The limitation of that study was that it was one ethnic group, so the remaining question was “is this applicable to everybody else?”
We’ve also had the NIH-sponsored Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) worldwide study, which looked at nearly 25,000 pregnancies and correlated mothers’ blood sugar with outcomes for both themselves and their babies. The limitation of the HAPO study is that, to-date, it has only looked at birth weights and adiposity.
The advantages of the research by Kubo et al. is that it includes multiple ethnic groups, so it goes beyond the Pima Indian study, and that it looks at an average age of almost 4 years in the offspring, so it is a longer follow-up than what we have had available.
The important consideration here is that the intrauterine environment to which babies are exposed clearly has long-term consequences. What is happening goes beyond genetics; it is now environmental. It is that intrauterine exposure that starts the vicious cycle of increased adiposity, obesity and diabetes, which then recapitulates from generation to generation. Our efforts really need to move toward breaking that cycle prior to pregnancy and providing a healthier intrauterine environment.
For More Information:
Pettitt DJ. Diabetes. 1991;doi:10.2337/diab.40.2.S126.
Metzger BE. N Engl J Med. 2008;doi:10.1056/NEJMoa0707943.
Click Here to Manage Email Alerts