The influence of maternal blood glucose during pregnancy on weight outcomes at birth and preschool age in offspring exposed to hyperglycemia first detected during pregnancy, in a South African cohort

Abstract

Introduction Little is known about the influence of hyperglycemia first detected in pregnancy (HFDP) on weight outcomes in exposed offspring in Africa. We investigated the influence of maternal blood glucose concentrations during pregnancy on offspring weight outcomes at birth and preschool age, in offspring exposed to HFDP, in South Africa. Research design and methods Women diagnosed with HFDP had data routinely collected during the pregnancy and at delivery, at a referral hospital, and the offspring followed up at preschool age. Maternal fasting, oral glucose tolerance test 1 and 2-hour blood glucose were measured at diagnosis of HFDP and 2-hour postprandial blood glucose during the third trimester. Offspring were classified as either those exposed to diabetes first recognized in pregnancy (DIP) or gestational diabetes (GDM). At birth, neonates were classified into macrosomia, low birth weight (LBW), large for gestational age (LGA), appropriate (AGA) and small for gestational age (SGA)groups. At preschool age, offspring had height and weight measured and Z-scores for weight, height and BMI calculated. Results Four hundred and forty-three neonates were included in the study at birth, with 165 exposed to DIP and 278 exposed to GDM. At birth, the prevalence of LGA, macrosomia and LBW were 29.6%, 12.2% and 7.5%, respectively, with a higher prevalence of LGA and macrosomia in neonates exposed to DIP. At pre-school age, the combined prevalence of overweight and obesity was 26.5%. Maternal third trimester 2-hour postprandial blood glucose was significantly associated with z-scores for weight at birth and preschool age, and both SGA and LGA at birth. Conclusion In offspring exposed to HFDP, there is a high prevalence of LGA and macrosomia at birth, and overweight and obesity at preschool age, with higher prevalence in those exposed to DIP, compared to GDM. Maternal blood glucose control during the pregnancy influences offspring weight at birth and preschool age.

Hyperglycemia First Detected in Pregnancy in South Africa: Facts, Gaps, and Opportunities

“…The combined prevalence of overweight and obesity was 26.5% at pre-school age. Maternal third trimester 2-hour PG was associated with z-scores for birthweight and pre-school age weight, indicating that this population’s antenatal 2-hour PG was a modifiable risk factor ( 161 ).…”

Association between Maternal Blood Glucose Levels during Pregnancy and Birth Outcomes: A Birth Cohort Study

“…Higher early FPG levels were associated with restricted fetal growth in the second trimester, followed by a compensatory growth starting in the third trimester that culminated in a significant weight gain and an increased risk of LGA [26]. A cohort of offspring exposed to hyperglycemia first detected during pregnancy found that maternal postprandial 2-h PG in the third trimester of pregnancy was significantly associated with weight Z scores at birth and at preschool age, SGA and LGA at birth [27]. Indeed, OGTT values may help to identify varying degrees of maternal and fetal risk, since GDM mothers that experience two or more abnormal PGs have a more severe disruption of glucose homeostasis and insulin sensitivity compared to GDM mothers who experienced only one altered PG [28].…”

Early life programming of health and disease: The long‐term consequences of obesity in pregnancy

“…Clues with respect to the mechanism of programming by maternal obesity may be gained from studies of GDM because the long‐term health of offspring exposed to GDM is largely the same as that observed with maternal obesity, although obesity can occur without GDM and vice versa. As early as 2 years of age, GDM offspring exhibit markedly greater risk of obesity 113 and this persists into childhood 114–116 . Dabelea et al 117 .…”

“…As early as 2 years of age, GDM offspring exhibit markedly greater risk of obesity 113 and this persists into childhood. [114][115][116] Dabelea et al 117 followed up sibling pairs where one of the pair had been exposed to GDM and the other had not. Among people in their early 20s, those who had experienced GDM in foetal life had a BMI on average 2.6 kg m -2 greater than unexposed siblings.…”