Association between hyperglycaemia in pregnancy and growth of offspring in early childhood: The PANDORA study

Abstract

Background: Few studies have assessed whether children exposed to in utero hyperglycaemia experience different growth trajectories compared to unexposed children.

Objectives: To assess association of type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) with early childhood weight, length/height and body mass index (BMI) trajectories, and with timing and magnitude of peak BMI in infancy.

Methods: PANDORA is a birth cohort recruited from an Australian hyperglycaemia in pregnancy register, and women with normoglycaemia recruited from the community. Offspring growth measures were obtained from health records over a median follow-up of 3.0 years (interquartile range 1.9-4.0). This analysis included children born to Aboriginal mothers with in utero normoglycaemia (n = 95), GDM (n = 228) or T2D (n = 131). Growth trajectories (weight, length/height and BMI) were estimated using linear mixed models with cubic spline functions of child age.

Results: After adjustment for maternal factors (age, BMI, parity, smoking, and socioeconomic measures) and child factors (age, gestational age at birth, and sex), children born to mothers with T2D or GDM had lower weight, length/height and BMI trajectories in infancy than children born to mothers with normoglycaemia, but similar weight and BMI by completion of follow-up. Children exposed to T2D had lower mean peak BMI 17.6 kg/m² (95% confidence interval [CI] 17.3-18.0) than children exposed to normoglycaemia (18.6 kg/m² [18.1-18.9]) (p = 0.001).

Conclusions: Maternal hyperglycaemia was associated with differences in early childhood growth trajectories after adjustment for maternal BMI. Exploration of associations between in utero hyperglycaemia exposure and growth trajectories into later childhood is required.

Keywords: Aboriginal; child; diabetes; growth; pregnancy.

FIGURE 1

PANDORA study participants for growth trajectory analysis

FIGURE 2

Growth trajectories of Aboriginal children from 0 to 60 months of age, stratified by maternal glycaemic status in pregnancy (full model, maternal BMI not included). Only variables with p‐value ≤0.1 on stepwise multivariable analysis were included in final model for each outcome. All variables with p‐value ≤0.2 on univariate analysis were included in model building process. Final models for each outcome are as follows: Weight: child sex, maternal height, maternal smoking in pregnancy; height: child sex, maternal height, maternal smoking in pregnancy; BMI: child sex, maternal smoking in pregnancy, maternal age. Other variables included in modelling process: maternal educational attainment, maternal parity, child's gestational age at birth.

FIGURE 3

Growth trajectories of Aboriginal children from 0 to 60 months of age, stratified by maternal glycaemic status in pregnancy (including maternal BMI). Only variables with p‐value ≤0.1 on stepwise multivariable analysis were included in final model for each outcome. All variables with p‐value ≤0.2 on univariate analysis were included in model building process. Final models for each outcome are as follows: Weight: child sex, maternal BMI at first antenatal visit, maternal height, maternal smoking in pregnancy; height: child sex, maternal BMI at first antenatal visit, maternal height, maternal smoking in pregnancy; BMI: child sex, maternal BMI at first antenatal visit, maternal smoking in pregnancy, maternal age. Other variables included in modelling process: maternal educational attainment, maternal parity, child's gestational age at birth.