Target Health Blog

Association of Gestational Diabetes With Maternal Disorders of Glucose Metabolism and Childhood Adiposity

September 17, 2018

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Metabolism
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Diabetes is a disease that occurs when blood glucose is too high. Over time, having high glucose blood levels can cause health problems, such as heart disease, nerve damage, eye problems, and kidney disease. An estimated 30.3 million people in the United States, or 9.4% of the population, have diabetes. About one in four people with diabetes don't know they have the disease and an estimated 84.1 million Americans aged 18 years or older have prediabetes.

According to an article published in JAMA (11 September 2108), a follow-up study was performed to examine associations, 10 to 14 years' postpartum, of gestational diabetes with maternal glucose metabolism and childhood adiposity. Study results were obtained from The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study, which established associations of gestational diabetes with perinatal outcome. The current follow-up study (HAPO-FUS), evaluated the long-term outcomes (4,697 mothers and 4832 children; study visits occurred between February 13, 2013, and December 13, 2016). None of the women in HAPO-FUS were diagnosed with or treated for gestational diabetes during their pregnancy. HAPO recruited an international, racially and ethnically diverse group. Limitations of the data in HAPO include that body mass index was obtained during pregnancy, not before. As well, HAPO-FUS did not collect data on the women or children's lifestyles to evaluate other factors that could contribute to obesity or type 2 diabetes. For the follow-up study, gestational diabetes was defined post hoc using criteria from the International Association of Diabetes and Pregnancy Study Groups consisting of 1 or more of the following: 1) 75-g oral glucose tolerance test results (fasting plasma glucose =92 mg/dL; 2) 1-hour plasma glucose level =180 mg/dL; 3) 2-hour plasma glucose level =153 mg/dL).

The primary maternal outcome was a disorder of glucose metabolism (composite of type 2 diabetes or prediabetes). The primary outcome for children: being overweight or obese; secondary outcomes: obesity, body fat percentage, waist circumference, and sum of skinfolds (>85th percentile for latter 3 outcomes).

Results showed that for children born to mothers with elevated or normal glucose, no statistically significant difference between the two groups of children in terms of their combined overweight and obesity, the study's primary outcome. However, when obesity was measured alone, children of mothers with elevated blood glucose were significantly more likely to be obese. For example, using BMI, 19% of children born to mothers with elevated blood glucose were obese, compared with 10% for children of mothers with normal glucose. The study also found the harms of even modestly elevated blood glucose for both mother and child extend more than a decade. Among women with elevated blood glucose during pregnancy, nearly 11% had type 2 diabetes at the follow-up study visit 10-14 years after childbirth, and about 42% had prediabetes. Of their counterparts who did not have elevated blood glucose during pregnancy, about 2% had type 2 diabetes and about 18% had prediabetes.

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