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Glycemic control in pregnancy associated with cardiometabolic profile in offspring
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Maternal gestational diabetes influences children’s risks for abnormal glucose tolerance, overweight and obesity at age 7 years, with poorer maternal glucose control having a greater effect on cardiometabolic profile in offspring, according to data in a large prospective study from China.
“Consistent with a previous report, the graded effect of maternal hyperglycemia on obesity and adiposity in offspring was most evident among girls,” Wing Hung Tam, MD, of the department of obstetrics and gynecology at Chinese University of Hong Kong, and colleagues wrote. “These findings suggest that boys and girls might differ in the immediate and latest responses of adiposity and glucose metabolism to maternal hyperglycemia.”
Tam and colleagues analyzed data from 970 Chinese mother–child pairs participating in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. All women underwent a standard 75-g oral glucose tolerance test between 24 and 32 weeks’ gestation; plasma glucose was measured between 34 and 37 weeks. At the 7-year follow-up, mothers underwent two OGTTs; children underwent five OGTTs to measure plasma glucose and insulin levels. Researchers also measured C-peptide level, lipid profile, and renal and liver function. Women in the HAPO study received no antenatal or postnatal interventions, and their glycemic status during the index pregnancy remained undisclosed. Primary outcome for the follow-up study was the rate of abnormal glucose tolerance (defined as impaired glucose tolerance, impaired fasting glucose or diabetes) in the children of mothers retrospectively classified as having gestational diabetes during the index pregnancy (n = 132).
Researchers found that, at age 7 years, children of mothers who had gestational diabetes had higher rates of abnormal glucose tolerance vs. children born to mothers without gestational diabetes (4.7% vs. 1.7%; P = .04). Children of mothers who had gestational diabetes also exhibited higher 30- and 60-minute plasma glucose levels during the OGTT (mean, 7.99 mmol/L vs. 7.54 mmol/L; 6.3 mmol/L vs. 5.87 mmol/L, respectively), as well as larger area under the curve during the OGTT (P = .002), lower oral disposition indices (P = .04) and a trend toward lower insulinogenic indices at 30 minutes (P = .05), according to the researchers. These children also had higher mean BMI (15.3 kg/m² vs. 15 kg/m²; P = .04), were more likely to have overweight or obesity (22.7% vs. 15.3%; P = 03) and had higher mean systolic and diastolic blood pressures (P = .01 and .06, respectively).
Researchers found that every 1-standard deviation increase in maternal fating glucose levels during pregnancy increased the risk for abnormal glucose tolerance in children at age 7 years (adjusted OR = 1.85; 95% CI, 1.2-2.86), as did maternal 1-hour plasma glucose during pregnancy (adjusted OR = 1.95; 95% CI, 1.18-3.22) and maternal 2-hour plasma glucose during pregnancy (adjusted OR = 2; 95% CI, 1.21-3.31). Associations were independent of BMI before pregnancy, childhood obesity or status as large for gestational age.
All three maternal glucose measures were also associated with increased adjusted ORs for childhood overweight or obesity and for adiposity among girls, but not boys.
“Despite the low frequency of abnormal glucose tolerance among children of this young age, this cardiometabolic risk might continue to increase throughout adolescence into adulthood,” the researchers wrote. “A multicenter follow-up study of offspring (aged 8 to 12 years) of mothers recruited from 10 of the original 15 HAPO study centers is underway. While this larger-scale, multiethnic study will shed light on the long-term consequences of [gestational diabetes], our data emphasize the need to follow up with offspring of mothers with [gestational diabetes] who are at risk for reduced beta-cell function and abnormal glucose tolerance, especially in Asia, where [gestational diabetes], childhood obesity, young-onset [diabetes] and premature chronic diseases are rampant.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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