Long-term effects of diabetes during pregnancy on the offspring

Influencing factors of glycemic control in singleton pregnancies complicated by gestational diabetes mellitus in western China: A retrospective study

To investigate the factors influencing glycemic control in gestational diabetes mellitus (GDM) patients and their impacts on pregnancy outcomes, providing insights for GDM management. Pregnant women diagnosed with GDM at a tertiary hospital in western China in 2019. Participants were categorized based on varying levels of glycemic control during pregnancy. A retrospective analysis was conducted, utilizing univariate and multivariate regression analyses, to identify factors influencing glycemic control in GDM patients. Based on various approaches to manage glucose, subjects were categorized into A1 (diet and exercise guidance alone) and A2 (insulin usage) groups. Based on whether glucose levels met the glycemic target in women with GDM, subjects were further divided into satisfactory and unsatisfactory groups. A total of 2621 women meeting the inclusion criteria were enrolled in the study. Independent factors associated with GDM A2 included higher prepregnancy body mass index (odds ratio [OR] = 1.070, 95% confidence interval [CI]: 1.019-1.122, P = .006), a history of GDM (OR = 1.888, 95% CI: 1.052-3.389, P = .033), elevated fasting plasma glucose (FPG) in early pregnancy (OR = 1.828, 95% CI: 1.320-2.532, P < .001), elevated 1-hour postprandial glucose (1-h PG) (OR = 1.126, 95% CI: 1.0091.256, P = .034), and 2-h PG by oral glucose tolerance test (OGTT) (OR = 1.181, 95% CI: 1.046-1.333, P = .007). Higher FPG by OGTT was an independent risk factor for unsatisfactory glycemic control (OR = 1.590, 95% CI: 1.273-1.985, P < .001). Compared with the A1 group, the A2 group has longer hospitalization, higher rates of cesarean section, placenta previa, and neonatal pneumonia (P < .05). Compared with the satisfactory group, the unsatisfactory group has lower gestational age, lower rates of cesarean section and placenta previa, and higher rates of postpartum hemorrhage for mothers; lower length and weight, and higher rates of premature birth, jaundice, hypoglycemia, pneumonia, respiratory distress syndrome, anemia, hospitalization, and hospitalization for more than 15 days in both pediatric unit and neonatal intensive care unit for newborns (P < .05). Elevated prepregnancy body mass index, FPG in early pregnancy, 1-h and 2-h PG during OGTT, and with a history with GDM are independent factors influencing insulin utilization, while elevated 0-h PG is an independent influencing factor of unsatisfactory glycemic control. Poor glycemic control has negative impacts on both maternal and fetal outcomes under 2 classifications.

The role of microRNAs in pregnancies complicated by maternal diabetes

With the global prevalence of diabetes increasing, more people of reproductive age are experiencing hyperglycaemic pregnancies. Maternal Type 1 (T1DM) or Type 2 (T2DM) diabetes mellitus, and gestational diabetes mellitus (GDM) are associated with maternal cardiovascular and metabolic complications. Pregnancies complicated by maternal diabetes also increase the risk of short- and long-term health complications for the offspring, including altered fetal growth and the onset of T2DM and cardiometabolic diseases throughout life. Despite advanced methods for improving maternal glucose control, the prevalence of adverse maternal and offspring outcomes associated with maternal diabetes remains high. The placenta is a key organ at the maternal-fetal interface that regulates fetal growth and development. In pregnancies complicated by maternal diabetes, altered placental development and function has been linked to adverse outcomes in both mother and fetus. Emerging evidence suggests that microRNAs (miRNAs) are key molecules involved in mediating these changes. In this review, we describe the role of miRNAs in normal pregnancy and discuss how miRNA dysregulation in the placenta and maternal circulation is associated with suboptimal placental development and pregnancy outcomes in individuals with maternal diabetes. We also discuss evidence demonstrating that miRNA dysregulation may affect the long-term health of mothers and their offspring. As such, miRNAs are potential candidates as biomarkers and therapeutic targets in diabetic pregnancies at risk of adverse outcomes.

Precision stratification of prognostic risk factors associated with outcomes in gestational diabetes mellitus: a systematic review

BACKGROUND

The objective of this systematic review is to identify prognostic factors among women and their offspring affected by gestational diabetes mellitus (GDM), focusing on endpoints of cardiovascular disease (CVD) and type 2 diabetes (T2D) for women, and cardiometabolic profile for offspring.

METHODS

This review included studies published in English language from January 1st, 1990, through September 30th, 2021, that focused on the above outcomes of interest with respect to sociodemographic factors, lifestyle and behavioral characteristics, traditional clinical traits, and 'omics biomarkers in the mothers and offspring during the perinatal/postpartum periods and across the lifecourse. Studies that did not report associations of prognostic factors with outcomes of interest among GDM-exposed women or children were excluded.

RESULTS

Here, we identified 109 publications comprising 98 observational studies and 11 randomized-controlled trials. Findings indicate that GDM severity, maternal obesity, race/ethnicity, and unhealthy diet and physical activity levels predict T2D and CVD in women, and greater cardiometabolic risk in offspring. However, using the Diabetes Canada 2018 Clinical Practice Guidelines for studies, the level of evidence was low due to potential for confounding, reverse causation, and selection biases.

CONCLUSIONS

GDM pregnancies with greater severity, as well as those accompanied by maternal obesity, unhealthy diet, and low physical activity, as well as cases that occur among women who identify as racial/ethnic minorities are associated with worse cardiometabolic prognosis in mothers and offspring. However, given the low quality of evidence, prospective studies with detailed covariate data collection and high fidelity of follow-up are warranted.

Associations between maternal and offspring glucose metabolism: a 9-year follow-up of a randomised controlled trial

Introduction

There is increasing evidence that the in utero environment affects the health and disease risk of offspring throughout their lives. The long-term effect of maternal hyperglycaemia on offspring glucose metabolism is of interest in a public health perspective. The aim of this study was to examine the association between in utero exposure to maternal glycaemia and offspring glucose metabolism.

Methods

Mother-child pairs were recruited from an RCT to prevent gestational diabetes mellitus where 855 healthy pregnant women were randomised to exercise or standard antenatal care. The original RCT detected no group differences in gestational diabetes mellitus prevalence or insulin resistance. The two groups were analysed as one group in the present study. Maternal glucose levels were assessed after 2-hour 75-gram oral glucose tolerance tests in pregnancy week ~34. Offspring outcomes were evaluated at ~9 years of age and included fasting glucose and homeostatic model assessment of insulin resistance. Multivariable regression models were performed, controlling for potential hereditary and lifestyle confounding factors.

Results

Complete data were available for 105 mother-child pairs. The regression analysis showed a positive association between maternal and offspring fasting glucose that was borderline significant (beta=0.18, 95% CI [-0.00027, 0.37], p=0.050). We did not find significant associations between maternal fasting glucose and offspring insulin resistance (beta=0.080, 95% CI [-0.087, 0.25], p=0.34), or between maternal 2-hour glucose and offspring fasting glucose (beta=0.016, 95% CI [-0.038, 0.070], p=0.56) or insulin resistance (beta=0.017, 95% CI [-0.032, 0.065], p=0.49).

Conclusions

Assessing a homogeneous group of healthy mother-child pairs, we found a borderline significant positive association between maternal and offspring fasting glucose, which persisted after adjustment for potential hereditary and lifestyle confounding factors. Our findings support other similar studies and highlight that improving the metabolic health of pregnant women, and women in childbearing age, should remain a key public health priority.

Clinical trial registration

ClinicalTrials.gov, identifier NCT00476567.

Effects of a low glycemic index or low glycemic load diet on pregnant women at high risk of gestational diabetes: A meta-analysis of randomized controlled trials

AIMS

To evaluate the effect of low glycemic index or low glycemic load diets on maternal and neonatal outcomes at high risk of gestational diabetes mellitus (GDM).

DATA SYNTHESIS

Several databases (PubMed, Cochrane Library, Web of Science, Embase, OVID, Clinical Trials. gov, China National Knowledge Infrastructure, China Biomedical Database, and Wanfang Database) were searched from January 1990 to January 2022 (updated to November 2022). Randomized controlled trials of low glycemic index diets interventions for women at high risk of GDM were included. From 2131 articles initially were screened, after eliminating duplicates, 1749 titles and abstracts were analyzed. 71 documents that met the inclusion criteria were selected and 3 documents were obtained through searching the reference lists. After reading the full text, 10 studies were retained. Two authors evaluated the studies, extracted data and conducted quality assessment independently. A total of 10 studies with 2304 patients met the inclusion criteria. Compared with the control group, a low glycemic index diet could control the range of weight gain (WMD -1.01, 95% CI -1.41 to -0.61), decrease the incidence of excessive weight gain (OR 0.69, 95% CI 0.54-0.87), lessen the incidence of large-for-gestational-age infants (OR 0.32, 95% CI 0.16-0.62) and reduce the incidence of preterm infants (OR 0.45, 95% CI 0.29-0.71).

CONCLUSION

A low glycemic index or low glycemic load diet could control maternal weight gain, reduce the incidence of excessive weight gain, and decrease the incidence of large-for-gestational-age infants and preterm infants in group with high risk of GDM.

PROSPERO

CRD42022322697.

Predictors and risk factors of short-term and long-term outcomes among women with gestational diabetes mellitus (GDM) and their offspring: Moving toward precision prognosis?

As part of the American Diabetes Association Precision Medicine in Diabetes Initiative (PMDI) - a partnership with the European Association for the Study of Diabetes (EASD) - this systematic review is part of a comprehensive evidence evaluation in support of the 2 nd International Consensus Report on Precision Diabetes Medicine. Here, we sought to synthesize evidence from empirical research papers published through September 1 st , 2021 to evaluate and identify prognostic conditions, risk factors, and biomarkers among women and children affected by gestational diabetes mellitus (GDM), focusing on clinical endpoints of cardiovascular disease (CVD) and type 2 diabetes (T2D) among women with a history of GDM; and adiposity and cardiometabolic profile among offspring exposed to GDM in utero. We identified a total of 107 observational studies and 12 randomized controlled trials testing the effect of pharmaceutical and/or lifestyle interventions. Broadly, current literature indicates that greater GDM severity, higher maternal body mass index, belonging to racial/ethnic minority group; and unhealthy lifestyle behaviors would predict a woman's risk of incident T2D and CVD, and an unfavorable cardiometabolic profile among offspring. However, the level of evidence is low (Level 4 according to the Diabetes Canada 2018 Clinical Practice Guidelines for diabetes prognosis) largely because most studies leveraged retrospective data from large registries that are vulnerable to residual confounding and reverse causation bias; and prospective cohort studies that may suffer selection and attrition bias. Moreover, for the offspring outcomes, we identified a relatively small body of literature on prognostic factors indicative of future adiposity and cardiometabolic risk. Future high-quality prospective cohort studies in diverse populations with granular data collection on prognostic factors, clinical and subclinical outcomes, high fidelity of follow-up, and appropriate analytical approaches to deal with structural biases are warranted.

Risks of overweight in the offspring of women with gestational diabetes at different developmental stages: A meta-analysis with more than half a million offspring

We conducted a meta-analysis to evaluate the association of maternal gestational diabetes mellitus (GDM) and offspring overweight from birth to adulthood, and to assess the effects of lifestyle interventions in women with GDM on this risk of offspring overweight. We identified literature from PubMed and 12 other electronic databases and retrieved relevant literature published before October 20, 2020. Random-effects model analysis was used to calculate relative risks (RRs) of overweight and weighted mean differences of body mass index among children stratified into different developmental stages. Forty-nine cohort studies (n = 559,377) and four randomized controlled trials (n = 1277) were included. We found that offspring of women with GDM were at an increased risk for overweight with age, from 1.14 (95% confidence interval [CI]: 1.06-1.22) under 5 years, 1.37 (95% CI: 1.31-1.44) at 5 to <10 years, 2.00 (95% CI: 1.79-2.23) at 10 to <18 years, to 2.05 (95% CI: 1.65-2.55) over 18 years of age (p < 0.05 for differences among groups). However, it was not observed that lifestyle interventions for GDM decreased the elevated overweight risk (RR: 0.94, 95% CI: 0.80-1.11, I²  = 0.0%). These findings highlight the need for adopting an active and healthy lifestyle in this high-risk group.

Dietary supplementation of inulin alleviates metabolism disorders in gestational diabetes mellitus mice via RENT/AKT/IRS/GLUT4 pathway

BACKGROUND

Gestational diabetes mellitus (GDM) has significant short and long-term health consequences for both the mother and child. There is limited but suggestive evidence that inulin could improve glucose tolerance during pregnancy. This study assessed the effect of inulin on glucose homeostasis and elucidated the molecular mechanisms underlying the inulin-induced antidiabetic effects during pregnancy.

METHOD

Female C57BL/6 mice were randomized to receive either no treatment, high-dose inulin and low-dose inulin for 7 weeks with measurement of biochemical profiles. A real-time² (RT²) profiler polymerase chain reaction (PCR) array involved in glycolipid metabolism was measured.

RESULTS

Inulin treatment facilitated glucose homeostasis in a dose-dependent manner by decreasing fasting blood glucose, advanced glycation end products and total cholesterol, and improving glucose tolerance. Suppressing resistin (RETN) expression was observed in the inulin treatment group and the expression was significantly correlated with fasting blood glucose levels. The ratios of p-IRS to IRS and p-Akt to Akt in liver tissue and the ratio of p-Akt to Akt in adipose tissue as well as the expression level of GLUT4 increased significantly after inulin treatment.

CONCLUSIONS

Our findings indicated improvement of glucose and lipid metabolism by inulin was to activate glucose transport through the translocation of GLUT4 which was mediated by insulin signaling pathway repairment due to decreased expression of RETN and enhanced phosphorylation of IRS and Akt in GDM mice.

Association between gestational period and obesity in children with the use of dermatoglyphic traits: A preliminary study

Events occurring during the gestational period can influence the development of diseases and conditions such as obesity. This study aimed to analyze the association between events occurring in the gestational period and the occurrence of obesity in children based on dermatoglyphic traits. The sample comprised 73 children born in 2009, living in Palhoça, Santa Catarina (SC), Brazil, regularly enrolled in public and private schools in that municipality and who are participants of an ongoing major cohort study project called Coorte Brasil Sul. The results show predictive traits of obesity when comparing BMI and fingerprint groups. Obese male group, presented the figure Ulnar Loop (UL) in the right hand (MDT1) thumb and greater number of ridges in the (MDSQL1) right thumb the greater the BMI; likewise, the older the woman getting pregnant the greater the number of ridges that the child presented in the (MESQL2) left index finger and (MESQL1) right thumb. The results obtained infer the presence of predictive traits of BMI ranges and a possible association between the dermatoglyphic traits of children with obesity and late pregnancy women.

Hyperglycaemia in Pregnancy and Anthropometric Parameters in the Offspring at 10 Years: A Community-Based Retrospective Cohort Study in Sri Lanka

BACKGROUND

Studies of developmental origins of health and disease have highlighted the possible role of intrauterine hyperglycaemia, increasing the future risk of obesity, diabetes, and cardiovascular diseases in the offspring. There is limited evidence from South Asian populations for risk estimates for childhood obesity that are attributable to maternal diabetes in utero.

OBJECTIVE

The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and anthropometric parameters in the offspring at 10-11 years of age.

METHODS

A community-based retrospective cohort study was conducted in Colombo district, Sri Lanka. In the first stage, children born in 2005 were identified, and the availability of antenatal records was assessed. In the second stage, the exposure status of participants was ascertained based on antenatal records and predefined criteria. In the third stage, height, weight, waist circumference, and triceps skinfold thickness (TSFT) of eligible participants were measured to ascertain the outcome status. Background characteristics were collected by interviewing mothers. A 24-hour dietary recall and a 3-day diet diary were recorded.

RESULTS

159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (nonexposed) participated. Mean ages (SD) of exposed and unexposed groups were 10.9 (0.3) and 10.8 (0.3) years, respectively. The median BMI (17.6 vs 16.1, p < 0.001), waist circumference (63 cm vs 59.3 cm, p < 0.001), and triceps skinfold thickness (13.7 mm vs 11.2 mm, p < 0.001) were significantly higher in the exposed group. Offspring of women with HIP were more likely to be overweight (aOR = 2.6, 95% CI 1.4-4.9) and have abdominal obesity (aOR = 2.7, 95% CI 1.1-6.5) and high TSFT (aOR = 2.2, 95% CI 1.06-4.7) at 10-11 years than children who were not exposed after adjusting for maternal BMI, maternal age at delivery, and birth order.

CONCLUSIONS

Intrauterine exposure to HIP is a significant determinant of overweight, high TSFT, and abdominal obesity in the offspring.

The Gut Microbiota in Women Suffering from Gestational Diabetes Mellitus with the Failure of Glycemic Control by Lifestyle Modification

Gestational diabetes mellitus (GDM) is prevalent worldwide, leading to a high risk of significant morbidity for both the mother and offspring with complications. Increasing evidences suggest that gut microbiota plays a role in the pathogenesis of GDM. Lifestyle modification is the cornerstones of GDM treatment. However, a number of patients whose blood glucose is not controlled by lifestyle modification still require exogenous insulin to control blood glucose. No observational study is available about the relationship between the gut microbiota in GDM patients and lifestyle modifications. Thus, we investigated the differences in gut microbiota between GDM patients with successful glycemic control (GDM1) and failure of glycemic control (GDM2) by lifestyle modifications. We sequenced the V3-V4 regions of 16S ribosomal ribonucleic acid (rRNA) gene from stool samples of 52 singleton pregnant women with 24-28 weeks of gestation. Our results showed that Blautia, Eubacterium_hallii_group, and Faecalibacterium in the gut microbiota showed significant differences among the normoglycemic mother, GDM1, and GDM2 groups, respectively. The combined diagnostic performance of Blautia, Eubacterium_hallii_group, and Faecalibacterium in differentiating GDM2 from GDM was considered as the most reasonable identification indicator. Gut bacteria may participate in the pathological development of GDM2 through the peroxisome proliferator-activated receptor (PPAR) signaling pathway. These results indicated that Blautia, Eubacterium_hallii_group, and Faecalibacterium had important characteristic changes in the gut microbiota of women with GDM2.

Long-term BMI and growth profiles in offspring of women with gestational diabetes

AIMS/HYPOTHESIS

Gestational diabetes mellitus (GDM) is reported to be associated with childhood obesity, however the magnitude of this association and relation to intrauterine growth is uncertain. We, therefore, aimed to assess whether the growth trajectories of large for gestational age (LGA) and non-LGA offspring of mothers with GDM (OGDM) are different until early adolescence. We also aimed to explore whether growth trajectories of OGDM differ from those of offspring of mothers with type 1 or 2 diabetes (ODM1, ODM2).

METHODS

We studied height and BMI standard deviation score (SDS) of the OGDM group, up to the age of 14 years, with subgroup analysis comparing LGA with non-LGA at birth as a reflection of the intrauterine environment. All mothers with GDM who delivered at the University Medical Center Utrecht between 1990 and 2006 were contacted to participate; informed consent was received for 104 OGDM of 93 mothers. Offspring data were collected through Dutch infant welfare centres. Recorded height and weight were converted to BMI and age- and sex-specific SDS values for Dutch children. Additionally, we compared the OGDM group with ODM1 and ODM2 groups in order to identify those offspring with the highest risk of becoming overweight. Growth trajectories were compared between non-LGA and LGA OGDM and between OGDM, ODM1 and ODM2, using a random-effects model. In the longitudinal follow-up a mean of 7.4 ± 2 measurements per infant were available.

RESULTS

Mothers had a prepregnancy BMI of 25.8 kg/m² and 24% of their infants were LGA at birth. Heights of OGDM were no different from those of the Dutch Growth Study. Non-LGA OGDM showed a BMI SDS comparable with that of the reference population, with a slight increase in early adolescence. LGA OGDM had a higher BMI SDS trajectory than non-LGA OGDM and the reference population, which plateaued at around 10 years of age. Comparison of growth trajectories of OGDM, ODM1 and ODM2 showed ODM2 to have the highest trajectory followed by ODM1 and OGDM, with the LGA counterparts of all three offspring groups in the highest BMI SDS ranges.

CONCLUSIONS/INTERPRETATION

Until early adolescence, OGDM have a BMI that is 0.5 SDS higher than that of the Dutch background population. LGA OGDM appear to be at particularly higher risk of being overweight in adolescence compared with non-LGA OGDM, putting them also at a higher lifetime risk of being overweight and developing obesity. ODM2 showed the highest BMI SDS values and had an average BMI SDS of +1.6 until the age of 14, when it became +2 SD. These results emphasize the importance of adequate recognition and timely treatment of maternal gestational diabetes to prevent fetal macrosomia in obstetrics.

Fetal overnutrition and offspring insulin resistance and β-cell function: the Exploring Perinatal Outcomes among Children (EPOCH) study

AIMS

To examine the associations of intrauterine exposure to maternal diabetes and obesity with offspring insulin resistance, β-cell function and oral disposition index in a longitudinal observational study of ethnically diverse offspring.

METHODS

A total of 445 offspring who were exposed (n=81) or not exposed (n=364) to maternal diabetes in utero completed two fasting blood measurements at mean (sd) ages of 10.5 (1.5) and 16.5 (1.2) years, respectively, and an oral glucose tolerance test at the second visit. We used linear mixed models and general linear univariate models to evaluate the associations of maternal diabetes and pre-pregnancy BMI with offspring outcomes.

RESULTS

Maternal diabetes in utero predicted increased insulin resistance [18% higher updated homeostatic model assessment of insulin resistance (HOMA2-IR), P=0.01; 19% lower Matsuda index, P=0.01 and 9% greater updated homeostatic model assessment of β-cell function (HOMA2-β), P=0.04]. Each 5-kg/m² increase in pre-pregnancy BMI predicted increased insulin resistance (11% greater HOMA2-IR, P<0.001; 10% lower Matsuda index, P<0.001; 6% greater HOMA2-β, P<0.001). Similar results were obtained in a combined model with both exposures. After adjustment for offspring BMI, only maternal diabetes was associated with higher HOMA2-IR (β=1.12, P=0.03) and lower Matsuda index (β=0.83, P=0.01). Neither exposure was associated with early insulin response or oral disposition index.

CONCLUSIONS

Intrauterine exposure to diabetes or obesity is associated with greater offspring insulin resistance than non-exposure, supporting the hypothesis that fetal overnutrition results in metabolic abnormalities during childhood and adolescence.

Prenatal, Obstetric and Perinatal Factors Associated With the Development of Childhood-Onset Type 2 Diabetes

OBJECTIVE

To explore associations among prenatal, obstetric and perinatal factors and the development of childhood-onset type 2 diabetes.

METHODS

This retrospective, case-control study utilized administrative data housed at the Manitoba Centre for Health Policy. De-identified health records were examined from a sample of 270 children (aged 10 to 17 years at time of diagnosis) with type 2 diabetes and 1341 children without type 2 diabetes matched for age, sex and geographic location. Patients and control subjects were linked to their de-identified biological mothers' health records. Prenatal, obstetric and perinatal factors were investigated. Univariate and multivariable conditional regression analyses were conducted to identify key factors associated with the development of type 2 diabetes in children.

RESULTS

The mean age at diagnosis was 13.1 years, and 61% of patients were girls. The majority (71.1%) of children with type 2 diabetes resided in rural areas. Exposure to maternal pregestational diabetes increased the odds of childhood-onset type 2 diabetes nearly 6-fold, and exposure to gestational diabetes carried a 4-fold increased risk. Breastfeeding was found to be protective, decreasing the risk of childhood-onset type 2 diabetes (odds ratio = 0.52, 95% confidence interval = 0.36-0.74). Low maternal income was significantly associated with development of childhood-onset type 2 diabetes (odds ratio = 6.67, 95% confidence interval = 3.01-14.79).

CONCLUSIONS

Health and social policies and programs are needed to provide financial, educational and clinical resources that target women whose pregnancies are affected by poverty, type 2 diabetes or gestational diabetes. Breastfeeding should be encouraged to aid in the prevention of childhood-onset type 2 diabetes.

Growth and BMI during the first 14 y of life in offspring from women with type 1 or type 2 diabetes mellitus

BACKGROUND

Infants of women with pregestational diabetes are at risk for developing obesity in later life. This study aimed to identify subgroups at highest risk, by studying growth profiles of offspring from women with type 1 or 2 diabetes mellitus (ODM1, ODM2) until the age of 14 y.

METHODS

Information from infant welfare centers was received for 78 ODM1 and 44 ODM2. Mean BMI SD scores (SDS) (based on 1980 nation-wide references) and height SDS (based on 2009 references) were calculated and included in a random-effects model. Values were compared to the 2009 Dutch growth study.

RESULTS

BMI SDS profiles differed between ODM1 and ODM2, with the highest mean BMI SDS profiles in ODM2. Other factors that affected growth profiles in these infants included the presence of maternal obesity, large for gestational age (LGA) at birth and in ODM2 a Dutch-Mediterranean origin.

CONCLUSION

Offspring of women with diabetes have higher BMI SDS profiles than observed in the 2009 Dutch growth study, with the highest BMI SDS in ODM2 who are LGA at birth and have obese mothers. Preventive strategies for offspring adiposity may include pursuing lower prepregnancy maternal BMI, prevention of LGA at birth, and prevention of increased weight gain during childhood.

Impact of the Implementation of New WHO Diagnostic Criteria for Gestational Diabetes Mellitus on Prevalence and Perinatal Outcomes: A Population-Based Study

Objectives. To determine the impact of the implementation of new WHO diagnostic criteria for gestational diabetes mellitus (GDM) on prevalence, predictors, and perinatal outcomes in Croatian population. Methods. A cross-sectional study was performed using data from medical birth certificates collected in 2010 and 2014. Data collected include age, height, and weight before and at the end of pregnancy, while perinatal outcome was assessed by onset of labor, mode of delivery, and Apgar score. Results. A total of 81.748 deliveries and 83.198 newborns were analysed. Prevalence of GDM increased from 2.2% in 2010 to 4.7% in 2014. GDM was a significant predictor of low Apgar score (OR 1.656), labor induction (OR 2.068), and caesarean section (OR 1.567) in 2010, while in 2014 GD was predictive for labor induction (OR 1.715) and caesarean section (OR 1.458) only. Age was predictive for labor induction only in 2014 and for caesarean section in both years, while BMI before pregnancy was predictive for all observed perinatal outcomes in both years. Conclusions. Despite implementation of new guidelines, GDM remains burdened with increased risk of labor induction and caesarean section, but no longer with low Apgar score, while BMI remains an important predictor for all three perinatal outcomes.

High-fructose diet in pregnancy leads to fetal programming of hypertension, insulin resistance, and obesity in adult offspring

BACKGROUND

Consumption of fructose-rich diets in the United States is on the rise and thought to be associated with obesity and cardiometabolic diseases.

OBJECTIVE

We sought to determine the effects of antenatal exposure to high-fructose diet on offspring's development of metabolic syndrome-like phenotype and other cardiovascular disease risk factors later in life.

STUDY DESIGN

Pregnant C57BL/6J dams were randomly allocated to fructose solution (10% wt/vol, n = 10) or water (n = 10) as the only drinking fluid from day 1 of pregnancy until delivery. After weaning, pups were started on regular chow, and evaluated at 1 year of life. We measured percent visceral adipose tissue and liver fat infiltrates using computed tomography, and blood pressure using CODA nonivasive monitor. Intraperitoneal glucose tolerance testing with corresponding insulin concentrations were obtained. Serum concentrations of glucose, insulin, triglycerides, total cholesterol, leptin, and adiponectin were measured in duplicate using standardized assays. Fasting homeostatic model assessment was also calculated to assess insulin resistance. P values <.05 were considered statistically significant.

RESULTS

Maternal weight, pup number, and average weight at birth were similar between the 2 groups. Male and female fructose group offspring had higher peak glucose and area under the intraperitoneal glucose tolerance testing curve compared with control, and higher mean arterial pressure compared to control. Female fructose group offspring were heavier and had higher percent visceral adipose tissue, liver fat infiltrates, homeostatic model assessment of insulin resistance scores, insulin area under the intraperitoneal glucose tolerance testing curve, and serum concentrations of leptin, and lower concentrations of adiponectin compared to female control offspring. No significant differences in these parameters were noted in male offspring. Serum concentrations of triglycerides or total cholesterol were not different between the 2 groups for either gender.

CONCLUSION

Maternal intake of high fructose leads to fetal programming of adult obesity, hypertension, and metabolic dysfunction, all risk factors for cardiovascular disease. This fetal programming is more pronounced in female offspring. Limiting intake of high fructose-enriched diets in pregnancy may have significant impact on long-term health.

Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review

CONTEXT

Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years.

EVIDENCE ACQUISITION

PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015.

EVIDENCE SYNTHESIS

Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity.

CONCLUSIONS

Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

Microvascular reactivity in women with gestational diabetes mellitus studied during pregnancy

AIM

To compare microvascular reactivity assessed in the skin using laser Doppler fluximetry (LDF) in women with gestational diabetes mellitus (GDM) and gestational age-matched control during pregnancy.

METHODS

110 pregnant women at ~33 weeks gestation participated in the study. Skin microvascular reactivity was evaluated by LDF, at rest, during the response to brief arterial occlusion (post occlusive hyperaemic response) and during sympathetically mediated vasoconstrictor response to deep inspiratory breath hold.

RESULTS

No statistically significant differences were found in the microvascular variables studied (resting and maximum rate flux, post-ischaemic reactive hyperaemia and deep inspiratory breath holds) between +GDM and -GDM groups women. In women with GDM there was a negative correlation between resting flux and the response to the oral glucose tolerance test (OGTT), r = -0.282 (p = 0.037). There was also a negative correlation between the response to the OGTT and the sympathetically mediated constrictor response to inspiratory breath holds (r = -.298, p = .030) but not in women with GDM (r = .102, r = .468).

CONCLUSION

Attenuated microvascular reactivity as an early marker of endothelial dysfunction is not present in women with GDM when assessed during pregnancy.

Predominant role of GIP in the development of a metabolic syndrome-like phenotype in female Wistar rats submitted to forced catch-up growth

Catch-up growth has been associated with the appearance of metabolic dysfunctions such as obesity and type 2 diabetes in adulthood. Because the entero-insular axis is critical to glucose homeostasis control, we explored the relevance of the incretins glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) in the development of these pathologies. Offspring of rat dams fed ad libitum (control [C]) or 65% food-restricted during pregnancy and suckling time (undernourished [U]) were weaned onto a high-fat (HF) diet (CHF and UHF, respectively) to drive catch-up growth. Both male and female UHF rats showed an obese phenotype characterized by hyperphagy, visceral fat accumulation, and adipocyte hypertrophy. High-fat diet induced deterioration of glucose tolerance in a sex-dependent manner. Female UHF rats experienced much more severe glucose intolerance than males, which was not compensated by insulin hypersecretion, suggesting insulin resistance, as shown by homeostatic model assessment of insulin resistance values. Moreover, female, but not male, UHF rats displayed enhanced GIP but not GLP-1 secretion during oral glucose tolerance test. Administration of the GIP receptor antagonist (Pro3)GIP to UHF female rats over 21 days markedly reduced visceral fat mass and adipocyte hypertrophy without variations in food intake or body weight. These changes were accompanied by improvement of glucose tolerance and insulin sensitivity. In conclusion, the exacerbated production and secretion of GIP after the catch-up growth seems to represent the stimulus for insulin hypersecretion and insulin resistance, ultimately resulting in derangement of glucose homeostasis. Overall, these data evidence the role of GIP as a critical link between catch-up growth and the development of metabolic disturbances.

The importance of gestational diabetes beyond pregnancy

Diabetes mellitus is the main health problem affecting Mexico's population. The mechanisms by which susceptibility to it is acquired and diabetes develops are topics of ongoing research. In order to prevent type 2 diabetes, one of the challenges is to fully understand gestational diabetes and the hormonal changes and altered carbohydrate metabolism that are associated with it during fetal development. A recent study by the Instituto Nacional de Perinatología found a 12.9% prevalence of gestational diabetes; if the current criteria suggested by the American Diabetes Association were applied, this figure would rise to almost 30%. Identifying mothers and children at high risk of developing diabetes mellitus and its comorbid conditions will help facilitate the timely implementation of preventive measures. This will be a rational use of economic resources in Mexico that will vitally benefit public health.

Increased risk for overweight among Swedish children born to mothers with gestational diabetes mellitus

OBJECTIVE

Investigate the effects of maternal gestational diabetes mellitus (GDM) on height, weight, and body mass index (BMI) in offspring compared both to their siblings and to age-specific BMI reference values in Sweden. Their parents present BMI was also investigated.

METHODS

The growth of 232 offspring to 110 women with at least one pregnancy with GDM, were studied up to 12 yr of age. Height and weight of children were collected from Health Care Centres and compared to age-specific reference values in Sweden. Self-reported height and weight of the parents were collected at follow-up.

RESULTS

For boys, weight was higher at birth and at 8-10 yr of age, giving a higher BMI at 7-10 yr of age. Girls had an accelerated height growth at all ages, combined with an increased weight of varying degree resulting in higher BMI at birth and at 4-12 yr of age. A similar pattern was observed in siblings born after a normal pregnancy. Median BMI of mothers at follow-up was 25.4 (18.3-59.5 n = 105) and 26.5 (18.6-38.1 n = 90) for fathers.

CONCLUSIONS

Children born to mothers with prior GDM have a higher risk of overweight and obesity later in life. This is most likely due to life style habits rather than intrauterine factors, as the same BMI pattern was found in siblings born after a normal pregnancy. However, the design of the study could not rule out the role of genetic factors. Priority should be given to early life style intervention in these families.

Insulin resistance and impaired pancreatic β-cell function in adult offspring of women with diabetes in pregnancy

CONTEXT

Offspring of women with diabetes during pregnancy have an increased risk of glucose intolerance in adulthood, but the underlying mechanisms are unknown.

OBJECTIVE

We aimed to investigate the effects of intrauterine hyperglycemia on insulin secretion and action in adult offspring of mothers with diabetes.

DESIGN, SETTING, AND PARTICIPANTS

A cohort of 587 Caucasian offspring, without known diabetes, was followed up at the age of 18-27 years. We included 2 groups exposed to maternal diabetes in utero: offspring of women with gestational diabetes mellitus (n = 167) or type 1 diabetes (n = 153). Two reference groups were included: offspring of women with risk factors for gestational diabetes mellitus but normoglycemia during pregnancy (n = 139) and offspring from the background population (n = 128).

MAIN OUTCOME MEASURES

Indices of insulin sensitivity and insulin release were calculated using insulin and glucose values from a standard oral glucose tolerance test (120 minutes, 75 g glucose). Pancreatic β-cell function taking the prevailing insulin sensitivity into account was estimated by disposition indices.

RESULTS

Both groups of offspring exposed during pregnancy to either maternal gestational diabetes or type 1 diabetes had reduced insulin sensitivity compared with offspring from the background population (both P < .005). We did not find any significant difference in absolute measures of insulin release. However, the disposition index was significantly reduced in both the diabetes-exposed groups (both P < .005).

CONCLUSION

Reduced insulin sensitivity as well as impaired pancreatic β-cell function may contribute to the increased risk of glucose intolerance among adult offspring born to women with diabetes during pregnancy.

Resveratrol prevents impairment in activation of retinoic acid receptors and MAP kinases in the embryos of a rodent model of diabetic embryopathy

Diabetes induces impairments in gene expression during embryonic development that leads to premature and improper tissue specialization. Retinoic acid receptors (RARs and retinoid X receptor [RXRs]) and mitogen-activated protein kinases (MAPKs) play crucial roles during embryonic development, and their suppression or activation has been shown as a determinant of the fate of embryonic organogenesis. We studied the activation of RARs and MAPKs in embryonic day 12 (E12) in embryos of rats under normal, diabetic, and diabetic treated with resveratrol ([RSV]; 100 mg/kg body weight) conditions. We found downregulation of RARs and RXRs expressions as well as their DNA-binding activities in the embryos exhibiting developmental delays due to diabetes. Furthermore, the phosphorylation of extracellular signal-regulated kinase (ERK) 1/2 was decreased and phosphorylation of c-Jun N-terminal kinase (JNK) 1/2 and p38 was increased. Interestingly, embryos of diabetic rats treated with RSV showed normalized patterns of RARs, RXRs, neuronal markers, and ERK, JNK and p38 phosphorylation.

Gestational diabetes and cardiovascular risk factors in the offspring: results from a cross-sectional study

BACKGROUND

While the association of gestational diabetes mellitus and abnormal glucose tolerance is beyond doubt, its associations with other cardiovascular disease risk factors in the offspring are less clearly established. Some of these associations, in particular overweight in the offspring, might be confounded by maternal overweight.

METHODS

Data on 12,542 children in the age of 3-17 years with full information about gestational diabetes mellitus and maternal BMI were available from the German nationwide KiGGS study. We calculated linear and logistic regression models for measurements of body composition, blood pressure, HbA(1c) and cholesterol values in the offspring with gestational diabetes mellitus as the explanatory variable, with and without adjustment for maternal BMI.

RESULTS

The prevalence of gestational diabetes mellitus in the dataset was 2.2%. Unadjusted regression analyses suggested weak positive effects of gestational diabetes mellitus on body composition measurements [e.g. a mean increase in BMI standard deviation scores (SDS) of 0.17 units (95% confidence interval: 0.03, 0.30)]. After adjustment for maternal BMI, the observed associations almost disappeared [e.g. BMI SDS: 0.07 (-0.06, 0.20)]. With respect to blood pressure and cholesterol, no potential effects of gestational diabetes mellitus were observed in both unadjusted and adjusted models.

CONCLUSION

Gestational diabetes mellitus does not appear to have a relevant effect on cardiovascular disease correlates such as blood pressure or cholesterol levels in children, and the potential effect of gestational diabetes mellitus on body composition seems to be widely explainable by maternal BMI.

Atypical fetal response to the mother's voice in diabetic compared with overweight pregnancies

OBJECTIVE

To characterize fetal spontaneous heart rate changes and movements and auditory-elicited heart rate changes in fetuses in diabetic pregnancies compared with those in uneventful, overweight pregnancies.

METHODS

Spontaneous heart rate and movements and maternal voice-elicited heart rate changes were observed in 46 mother-fetal pairs (n = 14 gestational diabetic and n = 32 overweight prepregnancy) at 36 (±1) weeks gestational age. Fetal heart rate changes, body movements, and breathing movements were observed for 20 minutes while the mother was at rest. Subsequently, each fetus was presented with a 2-minute audio recording of the mother's voice using the following 6-minute procedure: 2 minutes no-voice baseline, 2 minutes voice presentation, and 2 minutes no-voice postvoice period; heart rate was recorded continuously.

RESULTS

There were no differences in spontaneous heart rate changes, body movements, or breathing movements between the 2 groups. Fetuses in the overweight group showed an increase in the heart rate during the playing of their mother's voice, whereas fetuses in the diabetic group showed no response.

CONCLUSIONS

Fetuses in overweight pregnancies responded to the mother's voice with an increase in the heart rate as has been reported previously in uneventful pregnancies. The lack of response to the mother's voice in fetuses in diabetic pregnancies may represent immature neural or auditory system development, an increased sensorineural threshold, and thyroid or iron deficiency.

Gestational diabetes mellitus and risk of childhood overweight and obesity in offspring: a systematic review

We systematically reviewed research examining the association between gestational diabetes (GDM) and childhood overweight and obesity. We identified studies from three sources: (1) a PubMed search of articles published between January 1990–January 2011, (2) reference lists of publications from the PubMed search, and (3) reference lists of review articles. We included studies that examined GDM separately from pregestational diabetes and childhood overweight or obesity defined as BMI > 85th or 95th percentile. A total of 12 studies were included in the systematic review. Crude odds ratios for the relationship between GDM and childhood overweight or obesity ranged from 0.7 to 6.3; in 8 studies, the associations were not statistically significant. In only 3 studies were results adjusted for any confounders; in the 2 that adjusted for prepregnancy obesity, the GDM and childhood overweight or obesity associations were attenuated and not statistically significant after adjustment. This paper demonstrates inconsistent evidence of an association between GDM and offspring overweight and obesity due to the methodological limitations of existing studies. Recommendations for future research are presented, which address methodological challenges.

National Diabetes Data Group vs Carpenter-Coustan criteria to diagnose gestational diabetes

OBJECTIVE

The objective of the study was to compare perinatal outcomes among women diagnosed with gestational diabetes by the National Diabetes Data Group (NDDG) criteria with women meeting only Carpenter-Coustan criteria.

STUDY DESIGN

This was a 14 year retrospective cohort. Women who screened positive with 1 hour glucose load 140 mg/dL or greater underwent a diagnostic 3 hour oral glucose tolerance test. We report adjusted prevalence ratios (aPRs) of perinatal outcome risk.

RESULTS

Of the 4659 screen-positive women with diagnostic testing, 1082 (3.3%, of 33,179) met NDDG criteria; 1542 (4.6%, of 33,179), or 460 more, met Carpenter-Coustan criteria. These 460 untreated women had greater risk of preeclampsia than women diagnosed by NDDG criteria (aPR, 1.70; 95% confidence interval [CI], 1.23-2.35). They had a greater risk of cesarean delivery (aPR, 1.16; 95% CI, 1.04-1.30) and infants greater than 4000 g (aPR, 1.25; 95% CI, 1.01-1.56) than women not meeting either diagnostic criteria.

CONCLUSION

The 42.5% additional women diagnosed only by Carpenter-Coustan criteria are at greater risk for some adverse outcomes. Cost-effectiveness of a change remains to be determined.

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

AIMS/HYPOTHESIS

Offspring of mothers with diabetes are at increased risk of metabolic disorders in later life. Increased offspring BMI is a plausible mediator. We performed a systematic review and meta-analysis of studies examining offspring BMI z score in childhood in relation to maternal diabetes.

METHODS

Papers reporting BMI z scores for offspring of diabetic (all types, and pre- and during-pregnancy onset) and non-diabetic mothers were included. Citations were identified in PubMed; bibliographies of relevant articles were hand-searched and authors contacted for additional data where necessary. We compared offspring BMI z score with and without adjustment for maternal pre-pregnancy BMI. We performed fixed effect meta-analysis except where significant heterogeneity called for use of a random effects analysis.

RESULTS

Data were available from nine studies. In the diabetic group unadjusted mean offspring BMI z score was 0.28 higher (all diabetic mothers vs controls (95% CI 0.09, 0.47; p = 0.004; nine studies; offspring of diabetic mothers n = 927, controls n = 26,384) and with adjustment for maternal pre-pregnancy BMI, 0.07 higher (95% CI -0.15, 0.28; p = 0.54; three studies; offspring of diabetic mothers n = 244, controls n = 11,206). There was no evidence of a difference in offspring BMI z score in relation to type of diabetes (gestational vs type 1, p = 0.95).

CONCLUSIONS/INTERPRETATION

Maternal diabetes is associated with increased offspring BMI z score, although this is no longer apparent after adjustment for maternal pre-pregnancy BMI in the limited number of studies in which this is reported. Causal mediators of the effect of maternal diabetes on offspring outcomes remain to be established; we recommend that future research includes adjustment for maternal pre-pregnancy BMI.

The association of adverse pregnancy events and cardiovascular disease in women 50 years of age and older

OBJECTIVE

This study investigates the association between a prior history of pregnancy complications and cardiovascular disease (CVD) among Kentucky women aged ≥50 years.

METHODS

Data were analyzed from participants (n = 3909) in the Kentucky Women's Health Registry (2006-2008). Primary outcomes were self-reported prevalence of CVD, including angina, heart attack, heart failure, and arrhythmia. Pregnancy complications used as predictors were preterm labor, preeclampsia, gestational diabetes mellitus (GDM), and third trimester bleeding. Logistic regression analyses were conducted to determine associations between prevalence of CVD and pregnancy complications, controlling for age, education, and smoking status.

RESULTS

Overall, 199 (5.1%) women reported angina, 79 (2.0%) reported heart attack, 44 (1.1%) reported heart failure, and 642 (16.4%) reported arrhythmia. One pregnancy complication was reported by 614 (15.7%) women, and two or more complications were reported by 130 (3.3%) women. In regression models adjusting for age, education, and smoking, compared to women who were never pregnant, women with no pregnancy complications had a similar risk of reporting heart attack (odds ratio [OR] 1.2, 95% confidence interval [CI] 0.5-2.7), but women with one pregnancy complication (OR 2.5, 95% CI 1.03-6.0) and two or more complications (OR 4.2, 95% CI 1.4-10.6) had an increased risk. Similar results were seen for angina and arrhythmia, but not heart failure.

CONCLUSIONS

Women who experience pregnancy complications are more likely to report prevalent CVD (including angina, heart attack, and arrhythmia), suggesting a link between adverse pregnancy events and CVD. Pregnancy complications may serve as signals for future CVD, presenting an opportunity for early intervention and prevention.