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. 2025 Oct;68(10):2194-2204.
doi: 10.1007/s00125-025-06468-6. Epub 2025 Jun 17.

Association of maternal overweight and gestational diabetes mellitus with offspring adiposity trajectory: from birth to early adolescence

Yuzhi Deng  1   2   3 , Claudia H T Tam  1   2   3 , Aimin Yang  1   2   3 , Mai Shi  1   2   3 , Lai Yuk Yuen  4 , Noel Y H Ng  1   2   3 , Atta Y T Tsang  1   2   3 , Kit Ying Tsoi  1   2   3 , Risa Ozaki  1   2 , Albert M Li  5 , Elaine Chow  1   2   3 , Lai Ling Hui  6 , Juliana C N Chan  1   2   3 , Chi Chiu Wang  2   4 , Wing Hung Tam  4   7 , Ronald C W Ma  8   9   10
Affiliations

Association of maternal overweight and gestational diabetes mellitus with offspring adiposity trajectory: from birth to early adolescence

Yuzhi Deng et al. Diabetologia. 2025 Oct.

Abstract

Aims/hypothesis: We aimed to examine offspring adiposity trajectories from birth to age 9-14 years and to assess the joint associations of maternal overweight and gestational diabetes mellitus (GDM) with these trajectories.

Methods: This is a prospective cohort study with 564 mother-child dyads from the Hyperglycemia and Adverse Pregnancy Outcome study Hong Kong field centre. Assessments and anthropometric measurements were taken during pregnancy, at delivery and at median ages of 7 and 10 years postpartum. Offspring adiposity was primarily assessed using sum of skinfold thickness. We used linear mixed-effect models to evaluate the independent and joint associations of maternal overweight and GDM with the offspring adiposity trajectories, and applied group-based trajectory modelling to identify distinct patterns of adiposity development based on both statistical indices and clinical interpretability.

Results: Offspring skinfold thickness trajectories varied significantly based on maternal overweight and GDM (p<0.05). Group-based trajectory modelling identified two trajectory groups for skinfold thickness: 52.1% with slow increase and 47.9% with rapid increase. Combined maternal overweight and GDM was associated with 6.90-fold increased risk (95% CI 1.89, 33.32; p=0.006) of the rapidly increasing trajectory. Linear mixed-effect model analysis showed greater increases in skinfold thickness among offspring of mothers with either condition, with the highest trajectory observed in offspring of mothers with both conditions (β 1.62; 95% CI 0.69, 2.54; p=0.001).

Conclusions/interpretation: Maternal overweight and GDM are independently and jointly associated with rapidly increasing adiposity trajectories from birth to early adolescence. The findings underscore the importance of considering both maternal metabolic conditions when evaluating offspring adiposity risk.

Keywords: Gestational diabetes mellitus; Growth trajectory; Maternal BMI; Maternal hyperglycaemia; Offspring adiposity.

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Conflict of interest statement

Acknowledgements: The authors of the present study would like to thank the participants, researchers and others engaged in the Hong Kong HAPO study. YD acknowledges support from the Hong Kong PhD Fellowship Scheme. Some of the data were presented as an abstract at the EASD meeting in 2024. Data availability: Data collected for the study will not be made available to others. Funding: This work was partially funded by the University Grants Committee Research Grants Matching Scheme. The follow-up of the HAPO study at the Hong Kong field centre was supported by the General Research Fund of the Research Grants Council of the Hong Kong SAR, China (CUHK 473408, 471713, 14118718, 14102719). The HAPO study was funded by the National Institute of Child Health and Human Development (grant no. R01-HD34242) and the National Institute of Diabetes and Digestive and Kidney Diseases (grant no. R01-HD34243). The funding sources do not have any role in the design or interpretation of the study or the decision to publish the results. Authors’ relationships and activities: RCWM is a member of the editorial board of Diabetologia. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work. Contribution statement: YD conceptualised the study, performed formal analysis, utilised software, created visualisations and wrote the original draft. CHTT contributed to conceptualisation, methodology and validation, and reviewed and edited the manuscript. AY and MS contributed to methodology and manuscript review. LYY, NYHN, AYTT, KYT, RO, AML, EC, LLH and JCNC all contributed to conceptualisation and manuscript review. CCW and WHT contributed to conceptualisation, investigation and method development, provided resources and reviewed the manuscript. RCWM led the conceptualisation, investigation and methodology development, provided resources, contributed to the original draft, and reviewed and edited the manuscript. All authors reviewed and approved the final version of the manuscript. RCWM is the guarantor of this work, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Fig. 1
Fig. 1
Offspring sum of skinfold trajectory categories from birth to early adolescence from the group-based trajectory model. Two latent trajectory groups with quadratic functions were identified. The blue curve (group 1, n=294) is categorised as the slowly increasing skinfold thickness trajectory, and the orange curve (group 2, n=270) is categorised as the rapidly increasing skinfold thickness trajectory. Shadow indicates the corresponding 95% CIs
See this image and copyright information in PMC

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