Intrauterine Exposure to Gestational Diabetes, Child Adiposity, and Blood Pressure

Abstract

Background Intrauterine exposure to gestational diabetes mellitus (GDM) may promote offspring obesity and higher systolic blood pressure (SBP) by adolescence. Few studies have examined adiposity or SBP in younger children exposed to GDM. This study’s objective was to examine associations of maternal glucose tolerance during pregnancy with offspring adiposity and SBP at age 3 years. Methods We studied 1,238 mother-child pairs in Project Viva, a prospective prebirth cohort study. Exposures were maternal blood glucose following oral glucose load, and GDM confirmed by 3-h glucose tolerance test. Main child outcomes were age 3-year body mass index (BMI) z-score, the sum (SS+TR) and ratio (SS/TR) of subscapular (SS) and tricep (TR) skinfold thicknesses, and SBP. We performed adjusted multivariable analyses. Results Fifty-one (4%) mothers had GDM. 9.3% of 3 year-old children were obese and mean (s.d.) SBP was 92 (11) mm Hg. Children exposed to GDM had higher SBP (3.2 mm Hg, 95% confidence interval (CI): 0.4, 5.9, P = 0.02) and greater adiposity when assessed by the sum of skinfolds (SS+TR 1.31 mm, 95% CI: 0.08, 2.55, P = 0.04) but not by BMI z-score (−0.08 units, 95% CI: −0.37, 0.22, P = 0.61). After additional adjustment for the sum of skinfold thicknesses (SS+TR), the relationship between GDM and SBP was attenuated and no longer significant (2.6 mm Hg, 95% CI: −0.2, 5.4, P = 0.07). Conclusions Children exposed to GDM have higher adiposity, which may mediate the higher SBP in these children. These findings extend to younger children the adverse effects of GDM previously found among adolescents and adults.

Diabetes in Pregnancy and Childhood Cognitive Development: A Systematic Review

“…Consequently, the long-term effects of diabetes during pregnancy on later childhood health such as obesity/adiposity, mainly via large for gestational age at birth, has been clearly established. [13][14][15] In contrast, data regarding the longterm effects of maternal diabetes during pregnancy on the offspring's cognitive development are relatively limited and, when data are available, the findings are inconclusive. [16][17][18][19][20][21][22][23] The mechanisms by which maternal diabetes during pregnancy is associated with the offspring's cognitive development are unclear.…”

The diabetic pregnancy and offspring blood pressure in childhood: a systematic review and meta-analysis

“…Seven studies provided BP in offspring of mothers with GDM [24,25,29,34,36,39,40], and two in offspring of mothers with type 1 diabetes [32,33]. Four studies included pooled outcome data for offspring of both type 1 diabetes and GDM mothers [28,30,38,42]; one study included data from prepregnancy type 2 diabetes in their pooled diabetic group [28]; authors provided separate data for type 1 diabetes and GDM for three studies [30,38,42].…”

“…Five studies reported maternal prepregnancy BMI [25,30,36,39,40], and two studies reported offspring SBP data adjusted for prepregnancy maternal BMI [38,39]. A description of studies included is provided in Table 1.…”

“…The literature search identified 94 papers, of which 19 matched the inclusion criteria [11,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (Fig. 1).…”

“…Study quality A meta-analysis limited to studies scoring ≥5 out of 7 according to the Modified Newcastle-Ottawa Quality Assessment Scale (seven studies for SBP [24,29,30,33,34,36,39], six studies for DBP [24,29,30,33,34,36] Adjusted analyses In five studies, SBP was adjusted for covariates including offspring sex and age [33,34,36,38,39]. A meta-analysis of the adjusted data showed that SBP was higher in ODM than controls (2.43 mmHg [95% CI 0.90, 3.97]; p00.002; random-effects analysis; ESM Fig.…”