Hyperglycemia During Pregnancy and Long-Term Offspring Outcomes

Abstract

Purpose of review: This review will focus on the long-term outcomes in offspring exposed to in utero hyperglycemia and gestational diabetes (GDM), including obesity, adiposity, glucose metabolism, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, and puberty.

Recent findings: There is evidence, mostly from observational studies, that offspring of GDM mothers have increased risk of obesity, increased adiposity, disorders of glucose metabolism (insulin resistance and type 2 diabetes), and hypertension. In contrast, evidence from the two intervention studies of treatment of mild GDM and childhood measures of BMI, adiposity, and glucose tolerance do not demonstrate that GDM treatment significantly reduces adverse childhood metabolic outcomes. Thus, more evidence is needed to understand the impact of maternal GDM on offspring's adiposity, glucose metabolism, lipid metabolism, risk of fatty liver disease, and pubertal onset. Offspring of GDM mothers may have increased risk for metabolic and cardiovascular complications. Targeting this group for intervention studies to prevent obesity and disorders of glucose metabolism is one potential strategy to prevent adverse metabolic health outcomes.

Keywords: Childhood metabolic disease; Developmental programming of diabetes; Exposure to gestational diabetes mellitus; Gestational diabetes treatment effect on offspring; Long-term offspring outcomes; Pregnancy.

Fig. 1

This Forest plot shows that the five dichotomous measures of child adiposity at mean age of 11.4 years are significantly associated with GDM and the associations are strongest for obesity alone and sum of skinfolds

Fig. 2

Child glucose outcomes across categories of maternal glucose levels. The frequency of childhood IFG (a) and IGT (b) and means of the Matsuda index (c), insulinogenic index (d), and disposition index (e) across categories of fasting, 1-h, and 2-h PG is shown. Glucose categories are defined as follows: fasting PG level—category 1, < 4.2 mmol/L; category 2, 4.2–4.4 mmol/L; category 3, 4.5–4.7 mmol/L; category 4, 4.8–5.0 mmol/L; and category 5, 5.1 mmol/L or more; 1-h PG level—category 1, 5.8 mmol/L or less; category 2, 5.9–7.3 mmol/L; category 3, 7.4–8.6 mmol/L; category 4, 8.7–9.9 mmol/L; and category 5, ≥ 10.0 mmol/L; and 2-h PG level—category 1, ≤ 5.0 mmol/L; category 2, 5.1–6.0 mmol/L; category 3, 6.1–6.9 mmol/L; category 4, 7.0–8.4 mmol/L; and category 5, ≥8.5 mmol/L (from: Scholtens et al. Diabetes Care. 2019;42 [3]:381–92. American Diabetes Association [Diabetes Care, American Diabetes Association, 2019]. Copyright and all rights reserved. Material from this publication has been used with permission of American Diabetes Association) [34•]