Association of intrauterine exposure to maternal diabetes and obesity with type 2 diabetes in youth: the SEARCH Case-Control Study

Abstract

Objective: Limited data exist on the association between in utero exposure to maternal diabetes and obesity and type 2 diabetes in diverse youth. These associations were explored in African-American, Hispanic, and non-Hispanic white youth participating in the SEARCH Case-Control Study.

Research design and methods: A total of 79 youth with type 2 diabetes and 190 nondiabetic control youth aged 10-22 years attended a research visit. In utero exposures to maternal diabetes and obesity were recalled by biological mothers.

Results: Youth with type 2 diabetes were more likely to have been exposed to maternal diabetes or obesity in utero than were nondiabetic control youth (P < 0.0001 for each). After adjusting for offspring age, sex, and race/ethnicity, exposure to maternal diabetes (odds ratio [OR] 5.7 [95% CI 2.4-13.4]) and exposure to maternal obesity (2.8 [1.5-5.2]) were independently associated with type 2 diabetes. Adjustment for other perinatal and socioeconomic factors did not alter these associations. When offspring BMI was added, the OR for the association between in utero exposure to obesity and type 2 diabetes was attenuated toward the null (OR 1.1 [0.5-2.4]). Overall, 47.2% (95% CI 30.9-63.5) of type 2 diabetes in youth could be attributed to intrauterine exposure to maternal diabetes and obesity.

Conclusions: Intrauterine exposures to maternal diabetes and obesity are strongly associated with type 2 diabetes in youth. Prevention efforts may need to target, in addition to childhood obesity, the increasing number of pregnancies complicated by obesity and diabetes.

Figure 1—

Percentage of youth exposed in utero to maternal diabetes (A) and maternal overweight/obesity (B) by case-control status and race/ethnicity. □, case patients; ▪, control youth. A: Non-Hispanic white (NHW) P = 0.01; Hispanic (H) P = 0.02; African-American (AA) P = 0.02. B: NHW P = 0.1; H P = 0.04; AA P = 0.001.

Figure 2—

The association between offspring type 2 diabetes status with exposure to maternal diabetes in utero (A) and exposure to maternal overweight/obesity in utero (B) in sequentially adjusted multiple logistic regression models. Model 1: adjusted for offspring age, sex, race/ethnicity; model 2: model 1 + maternal obesity in utero (A) or maternal diabetes in utero (B); model 3: model 2 + maternal alcohol and smoking in pregnancy, maternal current age, parity, offspring's birth weight, breast-feeding, maternal education, household income; and model 4: model 2 + current offspring BMI Z score.