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

IMPORTANCE: The sequelae of gestational diabetes (GD) by contemporary criteria that diagnose approximately twice as many women as previously used criteria are unclear. OBJECTIVE: To examine associations of GD with maternal glucose metabolism and childhood adiposity 10 to 14 years’ postpartum. DESIGN...

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Published in:	JAMA : the journal of the American Medical Association 2018-09, Vol.320 (10), p.1005-1016
Main Authors:	Lowe, William L, Scholtens, Denise M, Lowe, Lynn P, Kuang, Alan, Nodzenski, Michael, Talbot, Octavious, Catalano, Patrick M, Linder, Barbara, Brickman, Wendy J, Clayton, Peter, Deerochanawong, Chaicharn, Hamilton, Jill, Josefson, Jami L, Lashley, Michele, Lawrence, Jean M, Lebenthal, Yael, Ma, Ronald, Maresh, Michael, McCance, David, Tam, Wing Hung, Sacks, David A, Dyer, Alan R, Metzger, Boyd E
Format:	Article
Language:	eng
Subjects:	Adipose tissue Adiposity Adolescent Adult Blood Glucose - analysis Body fat Body mass Body Mass Index Body size Body weight Child Children Complications Complications and side effects Criteria Cutoffs Diabetes Diabetes in pregnancy Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - etiology Diabetes, Gestational Female Follow-Up Studies Glucose Glucose metabolism Glucose tolerance Health aspects Humans Hyperglycemia Male Maternal & child health Metabolism Obesity Original Investigation Pediatric Obesity - etiology Postpartum Postpartum period Prediabetic State - etiology Pregnancy Pregnant women Risk factors Statistical analysis Waist Circumference Womens health
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Summary:	IMPORTANCE: The sequelae of gestational diabetes (GD) by contemporary criteria that diagnose approximately twice as many women as previously used criteria are unclear. OBJECTIVE: To examine associations of GD with maternal glucose metabolism and childhood adiposity 10 to 14 years’ postpartum. DESIGN, SETTING, AND PARTICIPANTS: The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study established associations of glucose levels during pregnancy with perinatal outcomes and the follow-up study evaluated the long-term outcomes (4697 mothers and 4832 children; study visits occurred between February 13, 2013, and December 13, 2016). EXPOSURES: 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 75-g oral glucose tolerance test results (fasting plasma glucose ≥92 mg/dL; 1-hour plasma glucose level ≥180 mg/dL; 2-hour plasma glucose level ≥153 mg/dL). MAIN OUTCOMES AND MEASURES: Primary maternal outcome: a disorder of glucose metabolism (composite of type 2 diabetes or prediabetes). 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: The analytic cohort included 4697 mothers (mean [SD] age, 41.7 [5.7] years) and 4832 children (mean [SD] age, 11.4 [1.2] years; 51.0% male). The median duration of follow-up was 11.4 years. The criteria for GD were met by 14.3% (672/4697) of mothers overall and by 14.1% (683/4832) of mothers of participating children. Among mothers with GD, 52.2% (346/663) developed a disorder of glucose metabolism vs 20.1% (791/3946) of mothers without GD (odds ratio [OR], 3.44 [95% CI, 2.85 to 4.14]; risk difference [RD], 25.7% [95% CI, 21.7% to 29.7%]). Among children of mothers with GD, 39.5% (269/681) were overweight or obese and 19.1% (130/681) were obese vs 28.6% (1172/4094) and 9.9% (405/4094), respectively, for children of mothers without GD. Adjusted for maternal body mass index during pregnancy, the OR was 1.21 (95% CI, 1.00 to 1.46) for children who were overweight or obese and the RD was 3.7% (95% CI, −0.16% to 7.5%); the OR was 1.58 (95% CI, 1.24 to 2.01) for children who were obese and the RD was 5.0% (95% CI, 2.0% to 8.0%); the OR was 1.35 (95% CI, 1.08 to 1.68) for body fat percentage and the RD was 4.2% (95% CI, 0.9% to 7.4%); the OR was 1.34 (95% CI, 1.08 to 1.67) for
ISSN:	0098-7484 1538-3598