[Hot Science] The influences of gestational diabetes mellitus on child cardiometabolic health

Background

• The influence of in utero hyperglycemia on fetal programming was first described  in 1980s
• The study aims to investigate the association between maternal hyperglycemia during pregnancy and cardiometabolic risk among offspring in early childhood

Subjects

• Chinese mothers seen at the Hong Kong study center from HAPO study and their children (~7 years of age) born form the index pregnancy were followed up (n = 970 pairs)

Method

• Biochemical tests,
  • All women (except those treated with antidiabetes drugs) received a 75-g oral glucose tolerance test (OGTT) at 2 time points
  • Children underwent an OGTT at 5 time points after a glucose load of 1.75 g/kg body weight or a 75-g glucose load if their body weight is ≥ 42.8 kg

• Outcome Measures,
  • Primary outcome: rate of abnormal glucose tolerance* in the offspring born to mothers retrospectively classified as suffering from GDM based on the WHO definition
    * Defined as the presence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes mellitus (DM), according to the American Diabetes Association diagnostic criteria
  • Secondary outcome: offspring’s insulin sensitivity, pancreatic ß-cell  function, oral disposition indices, BMI, blood pressure, overweight or obesity, adiposity and prehypertension and hypertension status

Key Findings

• At ~ 7 years of age, compared with children born to mothers without GDM, children of mothers with GDM had,
  • Higher 30- and 60-minute plasma glucose levels, larger AUC(G) at the OGTT
  • Higher rates of abnormal glucose tolerance
  • Lower oral disposition indices
  • A trend toward lower insulinogenic indices at 30 minutes
  • Higher BMI
  • Higher rate of overweight or obesity
  • Higher blood pressure
• Increased rates of overweight or obesity and adiposity were only noted among girls, and not boys among children born to mothers with GDM
  • Among girls, every 1-SD increment in maternal glycemic levels was related to an increase in the odds of overweight or obesity and  adiposity
• No significant differences in the history of breastfeeding, dietary habits and exercise levels between children born to mothers with and without GDM
• Maternal glycemic levels and GDM remained significantly correlated with an increased risk of abnormal glucose tolerance in the children in additional analysis with further adjustment for being born large for gestational age, adiposity at birth, overweight or obese or adiposity at the time of follow up

Conclusion

• This follow-up investigation of the HAPO study cohort demonstrated that maternal hyperglycemia raised the risk of abnormal glucose tolerance, obesity and hypertension among children in early childhood 

Link to the full article: http://care.diabetesjournals.org/content/40/5/679.full-text.pdf
 

Reference

Tam WH, Ma RCW, Ozaki R, Li AM, Chan MHM, Yuen LY, Lao TTH, Yang X, Ho CS, Tutino GE, Chan JCN. In utero exposure to maternal hyperglycemia increases childhood cardiometabolic risk in offspring. Diabetes Care. 2017;40(5):679-686
 

WYE-EM-035-FEB-18