Intrauterine Adiposity and BMI in 4- to 5-Year-Old Offspring from Diabetic Pregnancies

Abstract

Background: Pregnancies complicated by maternal diabetes are associated with disproportionate intrauterine growth that subsequently may lead to pediatric adiposity. Objectives: We investigated whether disproportionate intrauterine growth leads to differences in BMI in 4- to 5-year-old offspring from pregnancies complicated by type 1 (ODM1), type 2 (ODM2), or gestational diabetes (OGDM). Methods: Ultrasound data of fetal head-to-abdominal circumference (HC/AC) ratio obtained between 32 and 36 weeks of gestational age were related to offspring anthropometrics that were retrieved from infant welfare centers. Results: Data from 27 ODM1, 22 ODM2, and 24 OGDM were obtained. Ultrasound measurements for the HC/AC ratio were performed at a mean of 33-34 weeks, with a mean Z-score of the HC/AC ratio of -0.801, -0.879, and 0.017 in ODM1, ODM2, and OGDM. Mean BMI SDS was highest in ODM2 as compared to ODM1 and OGDM. In ODM1 there was a negative correlation between HC/AC ratio and BMI SDS at the ages of 4 and 5 years, but not in ODM2 or OGDM. The birth weight Z-score was positively correlated to BMI SDS in ODM2 and OGDM. Conclusion: Disproportionate intrauterine growth, expressed as the HC/AC ratio, was inversely related with BMI SDS in ODM1 at the ages of 4-5 years, but not in ODM2 or OGDM. Weight and maybe obesity in ODM1 offspring are likely to be related to intrauterine adiposity, whereas overweight in ODM2 and OGDM offspring seems more related to other factors such as birth weight centile, maternal obesity, and altered lifestyle factors during childhood.

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“…Hyperinsulinemia in-utero is associated with a 17-fold increase in incidence of metabolic syndrome and a tenfold increase in overweight, independent of birth weight [ 62 ]. Overweight is observed in children of 4 to 5 years of age, born to mothers with GDM and is associated with increased birth weight, maternal obesity [ 75 ], and/or altered lifestyle during childhood [ 76 ]. Children with a high birth weight who are exposed to an intrauterine environment of diabetes or maternal obesity have an increased risk of developing metabolic syndrome [ 56 , 77 ].…”

“…Further, pregnancies complicated with GDM and maternal obesity pose a higher risk for the development of metabolic syndrome in offspring, including CVD [ 69 , 76 , 78 – 80 ]. Maternal pre-gestational [ 66 , 81 , 82 ] and gestational body weight are strong predictors of body mass index (BMI) and percentage total body fat [ 67 ] in female but not male offspring [ 42 ].…”

“…Prenatal exposure to GDM concomitant with maternal obesity or overweight is a high-risk factor for high BMI in offspring [ 79 , 83 ]. However, for the development of offspring overweight and obesity, the risk attributed from maternal obesity is higher compared to GDM [ 76 , 80 ]. In addition, in a larger study, of 2,432,000 children over a 40-year period, the offspring of GDM pregnancies had a 29% increased rate of early-onset CVD [ 78 ] that was further increased in association with comorbidities such as maternal obesity [ 78 ].…”