Intrauterine exposure to gestational diabetes, child adiposity, and blood pressure

Abstract

Background: Intrauterine exposure to gestational diabetes mellitus (GDM) may promote offspring obesity and higher systolic blood pressure (SBP) by adolescence. Few studies have examined adiposity or SBP in younger children exposed to GDM. This study's objective was to examine associations of maternal glucose tolerance during pregnancy with offspring adiposity and SBP at age 3 years.

Methods: We studied 1,238 mother-child pairs in Project Viva, a prospective prebirth cohort study. Exposures were maternal blood glucose following oral glucose load, and GDM confirmed by 3-h glucose tolerance test. Main child outcomes were age 3-year body mass index (BMI) z-score, the sum (SS+TR) and ratio (SS/TR) of subscapular (SS) and tricep (TR) skinfold thicknesses, and SBP. We performed adjusted multivariable analyses.

Results: Fifty-one (4%) mothers had GDM. 9.3% of 3 year-old children were obese and mean (s.d.) SBP was 92 (11) mm Hg. Children exposed to GDM had higher SBP (3.2 mm Hg, 95% confidence interval (CI): 0.4, 5.9, P = 0.02) and greater adiposity when assessed by the sum of skinfolds (SS+TR 1.31 mm, 95% CI: 0.08, 2.55, P = 0.04) but not by BMI z-score (-0.08 units, 95% CI: -0.37, 0.22, P = 0.61). After additional adjustment for the sum of skinfold thicknesses (SS+TR), the relationship between GDM and SBP was attenuated and no longer significant (2.6 mm Hg, 95% CI: -0.2, 5.4, P = 0.07).

Conclusions: Children exposed to GDM have higher adiposity, which may mediate the higher SBP in these children. These findings extend to younger children the adverse effects of GDM previously found among adolescents and adults.

Figure 1

Associations of intrauterine exposure to gestational diabetes mellitus with body mass index (BMI) z-score, sum of subscapular and triceps skinfolds (SS+TR), and systolic blood pressure (SBP) at age 3 years, among 1,238 mother-child pairs in Project Viva. Estimates (95% confidence interval) adjusted for child sex and age; maternal education, race/ethnicity, smoking, parity, age, prepregnancy BMI, and pregnancy weight gain; paternal BMI; and birth weight z-score. SBP estimates are additionally adjusted for measurement conditions, maternal blood pressure, paternal hypertension, age 3 child height, and, in an an additional model*, the SS+TR.