Fetal growth rate tied to overweight risk for kids of mothers with gestational diabetes
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Key takeaways:
- Pregnant women with gestational diabetes have a higher fetal growth rate during the third trimester.
- Fetal growth rate attenuates risk for overweight among children of women with gestational diabetes
Fetal growth rate is higher for women with gestational diabetes in the third trimester, and that accelerated growth rate may contribute to an increased likelihood for overweight among children, according to study data from Denmark.
In a longitudinal cohort study of children born in Aarhus, Denmark, from 2008 to 2014, women with gestational diabetes had a higher fetal growth rate from week 25 until delivery than women with normal glucose levels. Children of mothers with gestational diabetes have greater risk for overweight from age 5 to 9 years than children of mothers with normal glucose tolerance during pregnancy. However, that risk was attenuated after adjusting for fetal growth rate, and became nonsignificant after a further adjustment for maternal prepregnancy BMI.
“Part of the risk of overweight in offspring of mothers with gestational diabetes could potentially be explained by a mediating effect of higher fetal growth rate in the third trimester,” Magnus Leth-Møller, MD, a PhD student in the departments of clinical medicine and obstetrics and gynecology at Aarhus University Hospital in Denmark, and colleagues wrote in a study published in The Journal of Clinical Endocrinology & Metabolism. “However, prepregnancy BMI also had a considerable effect on the risk of overweight in the offspring, suggesting that other factors, such as genetics and lifestyle, play a large role in the risk of overweight in offspring affected by gestational diabetes.”
Researchers collected data from singleton pregnancies occurring from 2008 to April 2014. Pregnant women without diabetes who had at least one ultrasound scan in addition to the first trimester scan, estimated fetal weight measurements from 19 weeks’ gestation until delivery and birth weight of the baby available were included. Gestational diabetes was defined as a plasma glucose of 162 mg/dL or higher on a 2-hour 75 g oral glucose tolerance test. Children were assessed for height and weight during follow-up at age 5 to 9 years. Children had overweight if they had a BMI z score of more than 1 standard deviation for their sex and age using WHO reference materials.
Of 6,794 children born in the study, 295 had mothers with gestational diabetes. Women with gestational diabetes had a higher weekly fetal growth rate from week 25 until week 38 than women with normal glucose tolerance. There were 258 women with gestational diabetes who were treated with diet and 37 treated with insulin. Children of mothers with insulin-treated gestational diabetes had a birth weight 324 g heavier than those treated with diet.
The prevalence of overweight at follow-up was 30.5% for children of mothers with gestational diabetes and 16.9% for those of mothers with normal glucose tolerance. After adjusting for smoking, maternal age and parity, children of mothers with gestational diabetes were more likely to have overweight at follow-up than children of mothers with normal glucose tolerance (adjusted OR = 2.02; 95% CI, 1.44-2.84). After adjusting for fetal growth rate from week 28 to delivery, children of mothers with gestational diabetes had a higher, but slightly attenuated, likelihood for overweight than those of mothers with normal glucose tolerance (aOR = 1.72; 95% CI, 1.2-2.43). No difference in overweight odds was found between the two groups after an additional adjustment for prepregnancy BMI.
“The reason why some children develop overweight is still largely unknown, but our results suggest that fetal growth rate might be a contributor and potentially an early predictor in pregnancies affected by gestational diabetes,” the researchers wrote.
In secondary analysis adjusting for smoking, parity, age and fetal growth rate, children of mothers with diet-treated gestational diabetes were more likely to have overweight than children of mothers with normal glucose tolerance (aOR = 1.75; 95% CI, 1.22-2.53). No increased risk for overweight was observed for children of mothers with insulin-treated gestational diabetes.
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