Association between maternal hyperglycemia in pregnancy and offspring anthropometry in early childhood: the pandora wave 1 study

Angela Titmuss^{1

2}, Federica Barzi^{3

4}, Elizabeth L M Barr^{3

5}, Vanya Webster³, Anna Wood^{3

6}, Joanna Kelaart⁷, Marie Kirkwood³, Christine Connors⁸, Jacqueline A Boyle^{3

9}, Elizabeth Moore¹⁰, Jeremy Oats¹¹, H David McIntyre¹², Paul Zimmet¹³, Alex D H Brown^{14

15

16

17}, Jonathan E Shaw⁵, Maria E Craig¹⁸, Louise J Maple-Brown^{3

6}

Affiliations

¹ Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. Angela.titmuss@menzies.edu.au.
² Paediatric Department, Division of Women, Child and Youth, Royal Darwin Hospital, Darwin, NT, Australia. Angela.titmuss@menzies.edu.au.
³ Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
⁴ Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD, Australia.
⁵ Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
⁶ Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
⁷ Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia.
⁸ Northern Territory Department of Health, Darwin, NT, Australia.
⁹ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹⁰ Public Health Unit, Aboriginal Medical Services Alliance of Northern Territory, Darwin, NT, Australia.
¹¹ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
¹² Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia.
¹³ Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
¹⁴ University of South Australia, Adelaide, SA, Australia.
¹⁵ Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
¹⁶ Australian National University, Canberra, ACT, Australia.
¹⁷ Telethon Kids Institute, Perth, WA, Australia.
¹⁸ School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.

PMID: 37608089
PMCID: PMC10599996
DOI: 10.1038/s41366-023-01366-6

Association between maternal hyperglycemia in pregnancy and offspring anthropometry in early childhood: the pandora wave 1 study

Angela Titmuss et al. Int J Obes (Lond). 2023 Nov.

. 2023 Nov;47(11):1120-1131.

doi: 10.1038/s41366-023-01366-6. Epub 2023 Aug 22.

Authors

Affiliations

¹ Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. Angela.titmuss@menzies.edu.au.
² Paediatric Department, Division of Women, Child and Youth, Royal Darwin Hospital, Darwin, NT, Australia. Angela.titmuss@menzies.edu.au.
³ Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
⁴ Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD, Australia.
⁵ Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
⁶ Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
⁷ Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia.
⁸ Northern Territory Department of Health, Darwin, NT, Australia.
⁹ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹⁰ Public Health Unit, Aboriginal Medical Services Alliance of Northern Territory, Darwin, NT, Australia.
¹¹ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
¹² Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia.
¹³ Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
¹⁴ University of South Australia, Adelaide, SA, Australia.
¹⁵ Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
¹⁶ Australian National University, Canberra, ACT, Australia.
¹⁷ Telethon Kids Institute, Perth, WA, Australia.
¹⁸ School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.

PMID: 37608089
PMCID: PMC10599996
DOI: 10.1038/s41366-023-01366-6

Abstract

Background: In-utero hyperglycemia exposure influences later cardiometabolic risk, although few studies include women with pre-existing type 2 diabetes (T2D) or assess maternal body mass index (BMI) as a potential confounder.

Objective: To explore the association of maternal T2D and gestational diabetes mellitus (GDM) with childhood anthropometry, and the influence of maternal BMI on these associations.

Methods: The PANDORA cohort comprises women (n = 1138) and children (n = 1163). Women with GDM and T2D were recruited from a hyperglycemia in pregnancy register, and women with normoglycemia from the community. Wave 1 follow-up included 423 children, aged 1.5-5 years (median follow-up age 2.5 years). Multivariable linear regression assessed associations between maternal antenatal variables, including BMI and glycemic status, with offspring anthropometry (weight, height, BMI, skinfold thicknesses, waist, arm and head circumferences).

Results: Greater maternal antenatal BMI was associated with increased anthropometric measures in offspring independent of maternal glycemic status. After adjustment, including for maternal BMI, children exposed to maternal GDM had lower mean weight (-0.54 kg, 95% CI: -0.99, -0.11), BMI (-0.55 kg/m², 95% CI: -0.91, -0.20), head (-0.52 cm, 95% CI: -0.88, -0.16) and mid-upper arm (-0.32 cm, 95% CI: -0.63, -0.01) circumferences, and greater mean suprailiac skinfold (0.78 mm, 95% CI: 0.13, 1.43), compared to children exposed to normoglycemia. Adjustment for maternal BMI strengthened the negative association between GDM and child weight, BMI and circumferences. Children exposed to maternal T2D had smaller mean head circumference (-0.82 cm, 95% CI: -1.33, -0.31) than children exposed to normoglycemia. Maternal T2D was no longer associated with greater child mean skinfolds (p = 0.14) or waist circumference (p = 0.18) after adjustment for maternal BMI.

Conclusions: Children exposed to GDM had greater suprailiac skinfold thickness than unexposed children, despite having lower mean weight, BMI and mid-upper arm circumference, and both GDM and T2D were associated with smaller mean head circumference. Future research should assess whether childhood anthropometric differences influence lifetime cardiometabolic and neurodevelopmental risk.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
PANDORA Wave 1 study participants.

**Fig. 2. Multivariable analysis of associations of maternal BMI and maternal glycemic status in pregnancy with child anthropometric outcomes.**
a Maternal BMI. b Gestational diabetes mellitus. c Type 2 diabetes in pregnancy.

**Fig. 3. Child anthropometric outcomes by maternal glycemic status in pregnancy and maternal body mass index (BMI) category.**
a Birthweight (g). b Child BMI (kg/m²). c Waist circumference (cm). d Mid-upper arm circumference (cm). e Suprailiac skinfold (mm). f Sum of skinfolds (mm).

See this image and copyright information in PMC

References

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Association between maternal hyperglycemia in pregnancy and offspring anthropometry in early childhood: the pandora wave 1 study

Affiliations

Association between maternal hyperglycemia in pregnancy and offspring anthropometry in early childhood: the pandora wave 1 study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical