Original Article
Gestational Diabetes Mellitus, Maternal Obesity, and Adiposity in Offspring

https://doi.org/10.1016/j.jpeds.2013.11.063Get rights and content

Objective

To determine the effects of maternal gestational diabetes mellitus (GDM) on offspring adiposity in a well-characterized cohort of Mexican American mother-child pairs.

Study design

This study included 62 Mexican American mothers and their index offspring. Maternal GDM and normal glucose status during index pregnancy were documented, and mothers were previously matched by age, body mass index (BMI), and parity. Mother-child pairs were recruited when offspring were between the ages of 5 and 16 years. A medical history was collected, and anthropometrics were measured. Main outcome measures were offspring BMI, BMI z-scores, BMI percentiles, and hip and waist circumferences.

Results

GDM-exposed offspring (n = 37) had greater measures of BMI (all P ≤ .02) and greater waist and hip circumferences (both P = .002) compared with 25 offspring of non-GDM mothers. Adjustment for offspring age, sex, Tanner stage, birth weight, months of breastfeeding, maternal prepregnancy BMI, and pregnancy weight gain attenuated the differences, but BMI z-score and BMI percentile remained significantly greater in the GDM-exposed group (P < .05).

Conclusion

Intrauterine exposure to GDM is associated with greater adiposity in Mexican American children, and this relationship is not mediated by maternal obesity. In contrast to previous reports, this study included only Mexican Americans; thus, ethnic variations may influence the contributions of maternal GDM and maternal obesity to offspring adiposity.

Section snippets

Methods

Participants are the index offspring of probands who participated in our BetaGene Study, which included women with documented GDM and age-, ethnicity-, postpartum BMI-, and parity-matched women with documented normal glucose levels in pregnancy. Details on the original BetaGene Cohort are described by Black et al.13 All study participants are self-reported Mexican American, as defined by at least three-quarters of grandparents of Mexican descent. Mothers were contacted by phone calls, and

Results

Sixty-two mother-child pairs participated in the study, 37 with GDM and 25 without GDM (Table I). During the index pregnancy from which the offspring were born, maternal age was ∼1 year lower in the GDM group. Participant-reported maternal weight before pregnancy, weight gain during pregnancy, and duration of breastfeeding after pregnancy were similar between groups. None of the mothers smoked during the index pregnancy. A greater fraction of infants in the GDM group were male, and that group

Discussion

We found that offspring of Mexican American mothers with GDM had greater BMI and waist and hip circumferences compared with offspring of non-GDM mothers. The differences were not explained by differences in maternal BMI and likely reflect greater adiposity in the GDM-exposed offspring.

Some previous studies have found that adjustments for maternal prepregnancy BMI attenuated associations between intrauterine exposure to GDM and childhood adiposity.3, 6 In contrast to these reports, we found that

References (22)

  • T.L. Crume et al.

    The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: the EPOCH study

    J Pediatr

    (2011)
  • J.N. Davis et al.

    Impact of gestational diabetes mellitus on pubertal changes in adiposity and metabolic profiles in latino offspring

    J Pediatr

    (2013)
  • N.M. Schlossberger et al.

    Validity of self-report of pubertal maturation in early adolescents

    J Adolesc Health

    (1992)
  • K.M. Flegal et al.

    Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010

    JAMA

    (2012)
  • K. Baptiste-Roberts et al.

    Gestational diabetes and subsequent growth patterns of offspring: the National Collaborative Perinatal Project

    Matern Child Health J

    (2012)
  • L.H. Philipps et al.

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

    Diabetologia

    (2011)
  • D. Dabelea et al.

    Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships

    Diabetes

    (2000)
  • D.A. Lawlor et al.

    Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort

    Diabetologia

    (2010)
  • B.E. Metzger

    Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring

    Clin Obstet Gynecol

    (2007)
  • G.V. Krishnaveni et al.

    Intrauterine exposure to maternal diabetes is associated with higher adiposity and insulin resistance and clustering of cardiovascular risk markers in Indian children

    Diabetes Care

    (2010)
  • T.D. Clausen et al.

    Overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus or type 1 diabetes

    J Clin Endocrinol Metab

    (2009)
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    Supported by the National Institutes of Health (K23 DK092702, UL1 RR031986, KL2 RR031991), American Heart Association (12CRP9430059), Robert E. and May R. Wright Foundation, and the James H. Zumberge Foundation. Study data were collected and managed using the Research Electronic Data Capture (REDCap) database in collaboration with Southern California Clinical and Translational Science Institute. The authors declare no conflicts of interest.

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