1420-P: Gestational Diabetes Glyburide Treatment and Glycemic Control: Associations with Risk of Subsequent Child Obesity

Abstract

Gestational diabetes mellitus (GDM) increases offspring obesity risk. GDM severity, treatment, glycemic control and postnatal feeding behaviors increase or alleviate child obesity risk. This study sought to evaluate GDM treatment (glyburide vs. diet) and glycemic control related to overweight/obesity risk in toddlers of mothers with GDM. In a diverse prospective cohort of 786 GDM mother-child dyads (78% minority: Hispanic, Asian, Black and 22% White) , we measured prenatal glycemic control (daily home testing) , GDM severity, treatment, postnatal diet, and child BMI at age 2-5 y. Maternal glycemia was categorized as optimal control (≥80% of fasting & post-prandial blood glucose tests met target) or not optimal control (<80%) . Child weight and height was categorized by BMI percentiles (age, sex) ; normal weight (<85th) , overweight (85-95th) or obese (>95th) . Multinomial logistic regression estimated odds ratios (OR) 95%CI of overweight and obesity associated with treatment and glycemic control adjusted for prenatal, newborn and postnatal covariates. On average, mothers were 33.3 (SD 4.7) y at delivery with prepregnancy BMI 29.3 (7.1) kg/m2 and 74% had optimal glycemic control. Children were age 40.5 (6.3) months at BMI measurement; 76% normal weight, 13% overweight and 11% obese. Glyburide was associated with higher risk of obesity, 1.75 (1.05-2.91) independent of glycemic control. Stratifying by glycemic control, glyburide was associated with borderline higher odds of obesity (2.79, 0.94-8.33, p=0.065) among those not in optimal control adjusted for GDM severity, pre-pregnancy BMI, sociodemographic, newborn size and infant diet. Longer breastfeeding was associated with lower odds of obesity (0.83, 0.75-0.93) and sugary drink or fruit juice intake birth to 1 y was associated with higher odds of obesity (4.14, 1.06-16.19) . Glyburide treatment of GDM and sugary infant diet may contribute to obesity in young children if maternal glycemic control was not optimal. Disclosure J.L.Josefson: n/a. E.P.Gunderson: None. B.Sun: None. M.Greenberg: None. L.Greenspan: None. J.N.Davis: None. B.E.Metzger: None. J.C.Lo: None. M.S.Faith: None. W.Lowe: None. Funding National Institutes of HealthRDK122700