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Meta-Analysis
. 2018 Jan 12;13(1):e0190676.
doi: 10.1371/journal.pone.0190676. eCollection 2018.

Obesity and abnormal glucose tolerance in offspring of diabetic mothers: A systematic review and meta-analysis

Maki Kawasaki  1   2 , Naoko Arata  3 , Celine Miyazaki  1 , Rintaro Mori  1 , Toru Kikuchi  4 , Yoshihiro Ogawa  2   5 , Erika Ota  1   6
Affiliations
Meta-Analysis

Obesity and abnormal glucose tolerance in offspring of diabetic mothers: A systematic review and meta-analysis

Maki Kawasaki et al. PLoS One. .

Abstract

Background: Rising prevalence of childhood obesity and type 2 diabetes mellitus (T2DM) is an emerging public health issue.

Objectives: To investigate the association of maternal hyperglycemia exposure during pregnancy with obesity and abnormal glucose tolerance in offspring, and the age at occurrence.

Methods: We searched MEDLINE and EMBASE for observational studies on obesity and diabetes in offspring of diabetic mothers (gestational diabetes mellitus (GDM), type 1 diabetes mellitus (T1DM) and T2DM), and those on non-diabetic mothers. We performed fixed effect meta-analysis for all studies except when heterogeneity was detected. The quality of studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS).

Results: Twenty observational studies were included involving a total of 26,509 children. Offspring of GDM mother had higher BMI z-score in childhood (pooled MD: 0.14, 95%CI: 0.04-0.24, seven studies, 21,691children, low quality of evidence). Offspring of T1DM mothers had higher BMI z-score from prepubertal to adolescent (pooled MD: 0.35, 95% CI: 0.13-0.58, three studies, 844 children, low quality of evidence) compared with control. After adjustment for maternal pre-pregnancy BMI, this association remained in offspring of T1DM, but disappeared in those of GDM mothers. Offspring of GDM mother had higher 2-hour plasma glucose from prepubertal to early adulthood (pooled MD: 0.43 mmol/L, 95% CI: 0.18-0.69, five studies, 890 children), while those of T1DM mothers had higher rate of T2DM in 2-5 years old to early adulthood (pooled odds ratio [OR], 6.10: 95% CI: 1.23-30.37, two studies, 448 children, very low quality of evidence) compared with control. As there was only one study with offspring of T2DM mothers, evidence is sparse.

Limitations: Only observational studies were included, with a few adequately adjusted for covariables.

Conclusions: Exposure to maternal hyperglycemia was associated with offspring obesity and abnormal glucose tolerance especially in offspring of T1DM mothers, but the evidence relies on observational studies with low quality of evidence only.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram of search and study selection.
Fig 2
Fig 2
Forest plots of metabolic parameters in offspring of mothers with gestational diabetes mellitus and controls: (a), obesity or overweight, (b) BMI z-scores, (c) diabetes.
Fig 3
Fig 3
Forest plots of metabolic parameters in offspring of mothers with type 1 diabetes mellitus and controls: (a) obesity or overweight, (b) unadjusted BMI z-scores, (c) adjusted BMI z-scores, (d) diabetes.
See this image and copyright information in PMC

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