Gestational Diabetes Associated With Adiposity, Puberty Onset in Offspring
Increased fasting glucose, insulin resistance, and fat percentage were seen in adolescent offspring of mothers with gestational diabetes.
Adolescent children of women with gestational diabetes mellitus (GDM) were found to have an increase in percentage of body fat, an adverse cardiovascular and metabolic profile, and earlier onset of puberty in girls, according to a study published in Diabetes Care.
Researchers recruited 1350 women from the Danish National Birth Cohort and 2629 controls to participate in the study, from which 561 offspring of mothers with GDM and 597 controls in the same age range were identified. Both groups contained approximately equal numbers of male and female subjects, who ranged in age from 9 to 16 years at the time of examination.
Compared with controls, adolescent children of mothers with GDM had higher body mass index (BMI), waist-to-hip ratio, and fat percentages; lower lean mass percentages; increased fasting glucose, insulin, C-peptide, triglyceride, and homeostasis model-assessment insulin resistance (HOMA-IR) levels; increased systolic blood pressure; and reduced high-density lipoprotein cholesterol levels. Female offspring of women with GDM began puberty earlier than controls. However, this difference disappeared after adjustment for maternal pre-pregnancy BMI and the child's BMI.
The researchers also assessed whether an adverse cardiovascular and metabolic profile among the offspring of mothers with GDM was explained by their increase in adiposity compared with controls, because adiposity is one of the most important risk factors for IR, type 2 diabetes, and cardiovascular disease. Even after adjusting for both offspring BMI and maternal pre-pregnancy BMI, waist-to-hip ratio, fasting glucose level, and HOMA-IR level were all significantly higher in the GDM offspring.
A strength of the study is the large sample size and the statistical power to examine the long-term consequences of GDM on offspring over a period of 10 years. A limitation is that the study included women with either suspected or confirmed GDM and therefore may have included women without GDM. However, sensitivity analysis of groupings in a subsample of the women diagnosed according to a clinician's best judgment did not alter the results. An additional limitation involves a lack of detailed parent information, including pre-pregnancy maternal body composition and paternal health, which could account for genetic predisposition.
Disclosures: Professor Peter Damm has served as an investigator in a multicenter, multinational study by Novo Nordisk A/S on the use of insulins in pregnancy in women with type 1 and type 2 diabetes. Allan Vaag, MD, PhD, reports being employed by AstraZeneca.
Grunnet LG, Hansen S, Hjort L, et al. Adiposity, dysmetabolic traits and earlier onset of female puberty in adolescent offspring of women with gestational diabetes mellitus: a clinical study within the Danish National Birth Cohort [published online October 16, 2017]. Diabetes Care. doi: 10.2337/dc17-0514