Overweight status and intrauterine exposure to gestational diabetes are associated with children's metabolic health

Abstract

Background: Offspring of women with gestational diabetes (OGD) have greater risk for obesity and impaired metabolic health. Whether impaired metabolic health occurs in the absence of obesity is not clear.

Objective: The purpose of this study was to investigate the independent and interactive effects of intrauterine exposure to gestational diabetes and of children's current weight status on their metabolic health.

Methods: Children aged 5–10 years (n = 51) with and without intrauterine exposure to gestational diabetes (OGD vs. offspring of non-diabetic women [CTRL]) were grouped into normal weight (body mass index [BMI] < 85th %) and overweight (BMI > 85th %) according to Centers for Disease Control growth curves. Lipid profile was obtained by fasting blood draw, insulin sensitivity (SI) and secretion by liquid meal tolerance test, and body composition by dual-energy X-ray absorptiometry.

Results: Despite similar average BMI percentiles among normal weight OGD versus CTRL, and overweight OGD vs. CTRL, OGD had greater total %fat and trunk fat adjusted for leg fat compared with CTRL (P < 0.05). Overweight children had lower SI (P < 0.05) and greater basal, static, and total insulin secretion independent of SI (P < 0.05). OGD was independently associated with greater static insulin secretion (P < 0.05) and the interaction between OGD and overweight was associated with greater basal insulin secretion independent of SI (P < 0.01). OGD and overweight were each associated with lower high-density lipoprotein-cholesterol (HDL-C) (P < 0.05).

Conclusion: Intrauterine exposure to gestational diabetes was associated with greater central adiposity and insulin secretion, and lower HDL-C, irrespective of current weight status. Future research should examine respective contributions of the intrauterine environment and of underlying genotype on children's metabolic health.

Keywords: body composition; glucose; insulin; lipid; obesity; pediatric; pregnancy; prenatal programming.

Figure 1

(A) Total body % fat was greater among OW children (P<0.001), and those exposed to GDM in utero (P<0.05); (B) Trunk fat, relative to leg fat, was greater among OGD versus CTRL (P<0.01), and an interactive effect with weight status was noted whereby OW-OGD had more trunk fat adjusted for leg fat compared to children with just one risk factor (P<0.05). *P<0.05; **P<0.01; ***P<0.001.

Figure 2

(A) Insulin sensitivity (S_I) was lower among OW versus NW (P<0.01); (B) PhiB adjusted for S_I was higher among OW versus CTRL (P<0.01), and an interactive effect with intrauterine exposure to GDM implied higher PhiB among children with both risk factors as compared to those with only one risk factor (P<0.01); (C) PhiS, adjusted for S_I, was higher among OW versus NW (P<0.01) and among OGD versus CTRL (P<0.05); and (D) PhiTOT, adjusted for S_I, was higher among OW versus NW, irrespective of intrauterine exposure to GDM (P<0.001). *P<0.05; **P<0.01; ***P<0.001.

Figure 3

(A) Triglyceride concentrations were higher among OW versus NW children (P<0.05); and (B) HDL-C concentrations were lower among both OW versus NW (P<0.05) and OGD versus CTRL (P<0.05). *P<0.05; **P<0.01; ***P<0.001.