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

Abstract

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.

Figure 1

Flow diagram showing the number of studies included in and excluded from the systematic review for childhood obesity.

Figure 2

(a) Association of GDM and childhood overweight or obesity, unadjusted odds ratio, and 95% confidence interval. ^aAt the time this analysis was conducted, Kaiser Permanente used the NDDG criteria to diagnose and treat GDM. However, in the analysis, they calculated GDM using both criteria. Therefore, those meeting the NDDG criteria in this analysis were likely treated with diet or diet/insulin, but those meeting only the Carter and Coustan criteria were likely to not be treated. ^bUndefined because odds ratio could not be calculated with a zero cell. (b) Association of GDM and childhood overweight or obesity compared to a nondiabetic control group among studies that adjusted for any confounders, adjusted odds ratios, and 95% confidence intervals. ^aAdjusted for maternal BMI and child's age, gender, Tanner stage, TV watching, physical activity, energy intake, birth weight, breastfeeding duration, birth order, and mom's household income, mother's smoking, dietary restraint, weight cycling, weight concerns, and mother's current BMI. ^bAdjusted for maternal age, parity, weight gain during pregnancy, ethnicity, macrosomia at birth, and sex of child. ^cAdjusted for maternal prepregnancy BMI and sex, age at outcome, height, height squared, maternal age, social class, parity, smoking during pregnancy, mode of delivery, and maternal prepregnancy BMI. ^dAt the time this analysis was conducted, Kaiser Permanente used the NDDG criteria to diagnose and treat GDM. However, in the analysis, they calculated GDM using both criteria. Therefore, those meeting the NDDG criteria in this analysis were likely treated with diet or diet/insulin, but those meeting only the Carter and Coustan criteria were likely to not be treated.