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Maternal diabetes affects age of diabetes diagnosis, glycemic control in offspring
Children born to mothers who were diagnosed with diabetes before or during pregnancy were more likely to be diagnosed with type 2 diabetes at a younger age and have poorer HbA1c control, according to research in Diabetes Care.
Steven D. Chernausek, MD, of the University of Oklahoma Health Sciences Center, and colleagues analyzed data from 632 children aged 10 to 17 years diagnosed with type 2 diabetes within the previous 2 years who participated in the TODAY clinical trial between July 2004 and February 2009. Parents and caregivers reported participants’ medical history and parental diabetes status; children underwent an oral glucose tolerance test at baseline. Individuals with poor glycemic control (HbA1c 8% on metformin) were excluded from the study.
Within the cohort, 34% of mothers had diabetes during pregnancy with the participating child, 36% of whom had been diagnosed before pregnancy; 16% were diagnosed with diabetes after pregnancy. Half of the mothers in the cohort were never diagnosed with diabetes; 32% of biological fathers reported being diagnosed with diabetes at baseline.
Children whose mother had diabetes during pregnancy were diagnosed with diabetes at a significantly younger age (mean age at diagnosis, 13.3 years) than children born to mothers diagnosed with diabetes after pregnancy (mean age at diagnosis, 14 years) or never diagnosed (mean age at diagnosis, 13.9 years). Children of mothers diagnosed with diabetes during pregnancy also had an increased HbA1c vs. children of mothers never diagnosed with diabetes (6.2% vs. 5.9%; P < .0001). Researchers found no relationship between paternal diabetes status and blood glucose measures or insulin sensitivity.
Children of mothers diagnosed during pregnancy also had reduced beta-cell function (C-peptide index, 0.063 vs. 0.092), according to researchers. A similar effect of maternal diabetes on beta-cell function was found among non-Hispanic black and Hispanic children of mothers diagnosed with diabetes.
“The relationship between maternal diabetes and participants’ baseline metabolic status appears modest but may be meaningful considering the constraints on the sample examined,” the researchers wrote, noting that inclusion in the cohort required an HbA1c lower than 8%. “In this context, the increase in baseline HbA1c from 5.9% to 6.2% in those youth exposed to an intrauterine diabetes environment compared with those whose mother was never diagnosed may be meaningful, as the value approaches the threshold for vascular complication risk.”
The researchers noted that racial distinctions evident in the cohort require replication and additional research, as other factors may have influenced the results, including racial differences related to diabetes control or differences in perinatal care. – by Regina Schaffer
Disclosure: Becton, Dickinson and Company, Bristol-Myers Squibb, Eli Lilly and Company, GlaxoSmithKline, LifeScan Inc., Pfizer and Sanofi made donations in support of the TODAY study group’s efforts. Chernausek reports no relevant financial disclosures. One study researcher reports receiving a consulting fee and honorarium from Daiichi Sankyo, and another researcher reports consulting for Shire Pharmaceuticals.