Impact of gestational diabetes mellitus on pubertal changes in adiposity and metabolic profiles in Latino offspring

Abstract

Objective: To examine the impact of maternal gestational diabetes mellitus (GDM) status on longitudinal changes in adiposity and metabolic variables in overweight Latino offspring (from age 8-20 years) across puberty.

Study design: This longitudinal cohort of 210 overweight Latino children was measured annually for a period of 3 ± 1 years for Tanner stage through physical examination, adiposity by dual-energy X-ray absorptiometry and magnetic resonance imaging, lipids, and glucose and insulin action via the oral glucose tolerance test and frequently sampled intravenous glucose tolerance test. Linear mixed-effects modeling estimated the impact of maternal GDM status on baseline and changes in adiposity and metabolic variables across puberty.

Results: In our cohort, 22% of offspring were from GDM pregnancies. At baseline, the GDM offspring were heavier at birth, more likely to have a family history of type 2 diabetes, and less likely to have been breastfed (for any duration). Compared with the non-GDM offspring, the GDM offspring had greater increases in total body fat (+6.5% vs +4.5%; P = .03) and steeper declines in acute insulin response (-39% vs -17%; P < .001) and disposition index (-57% vs -35%; P < .001) across Tanner stages, independent of ethnicity, sex, breastfeeding status, family history of diabetes, and baseline and changes in body composition.

Conclusion: These findings confirm the elevated risk for excess adiposity and type 2 diabetes in GDM offspring, and further underscore the need for interventions targeting Latino GDM and their offspring.

Figure 1

Changes in total body fat mass (kg) for GDM offspring (n=47) and non-GDM offspring (n=163) across puberty. Data are presented as adjusted mean ±SEM of total body fat at each Tanner stage. There was a significant effect of GDM status on changes in total body fat across Tanner, with GDM offspring having an 6.5% increase in total body fat across Tanner compare with a 4.3% increase in non-GDM offspring across Tanner (ß=0.46 vs. ß=0.22; p=0.03).

Figures 2

Changes in insulin sensitivity (SI), acute insulin response (AIR) and disposition index (DI) for GDM offspring (n=47) and non-GDM offspring (n=163) across puberty. Data are presented as adjusted mean ±SEM of insulin action at each Tanner stage. There was a significant effect of GDM status on the slope of AIR, with GDM offspring having a 39.0% decline in AIR across Tanner compared with a 17% decline in non-GDM offspring (ß=−0.14 vs. ß=−0.10; p<0.001), independent of sex, birth weight, breastfeeding status, and family history of T2D. There was a significant effect of GDM status on the slope of disposition index (DI; a measure of β-cell function), with GDM offspring having a 50.7% decline in DI across Tanner compared with a 35.2% decline in non-GDM offspring (ß=−0.01 vs. ß=−0.10; p<0.001), independent of sex, birth weight, breastfeeding status, and family history of T2D. There were no significant differences between GDM and non-GDM offspring on changes in SI.