Abstract
BackgroundThis study examines the effect of diabetes in pregnancy on offspring weight at birth and ages 1 and 5 years.MethodsA population-based electronic cohort study using routinely collected linked healthcare data. Electronic medical records provided maternal diabetes status and offspring weight at birth and ages 1 and 5 years (n = 147,773 mother child pairs). Logistic regression models were used to obtain odds ratios to describe the association between maternal diabetes status and offspring size, adjusted for maternal pre-pregnancy weight, age and smoking status.FindingsWe identified 1,250 (0.9%) pregnancies with existing diabetes (27.8% with type 1 diabetes), 1,358 with gestational diabetes (0.9%) and 635 (0.4%) who developed diabetes post-pregnancy. Children whose mothers had existing diabetes were less likely to be large at 12 months (OR: 0.7 (95%CI: 0.6, 0.8)) than those without diabetes. Maternal diabetes was associated with high weight at age 5 years in children whose mothers had a high pre-pregnancy weight tertile (gestational diabetes, (OR:2.1 (95%CI:1.25–3.6)), existing diabetes (OR:1.3 (95%CI:1.0 to 1.6)).ConclusionThe prevention of childhood obesity should focus on mothers with diabetes with a high maternal pre-pregnancy weight. We found little evidence that diabetes in pregnancy leads to long term obesity ‘programming’.
Highlights
Diabetes in pregnancy is linked to complications in 2–5% of all pregnancies [1] and is commonly recognised as a modifier of growth and development of the foetus, with suggestions of long term ‘programming’ through fuel-mediated teratogenesis [2]
Each motherchild pair was stratified by mothers’ diabetes status; 144,530 (97.8) were exempt from diabetes, 2,608 (1.8%) had diabetes during the course of the pregnancy and 635 (0.4%) developed diabetes post pregnancy (12.2% of these women were hyperglycaemic during pregnancy)
We found at age 1 year offspring born to mothers with existing diabetes were less likely to be large in comparison with those born to mothers without diabetes, whilst no association was evident at age 5 years using complete data
Summary
Diabetes in pregnancy is linked to complications in 2–5% of all pregnancies [1] and is commonly recognised as a modifier of growth and development of the foetus, with suggestions of long term ‘programming’ through fuel-mediated teratogenesis [2]. Similar birth outcomes have been shown amongst offspring exposed to high maternal glucose levels below the diabetes threshold [7] Investigations into whether these adverse effects persist into later infancy and childhood are scarce and show inconsistent findings. Despite previously reporting adverse birth outcomes, a study [11] based on 15-centres worldwide did not find an association between varying levels of maternal glycaemia (below the diabetic threshold) and obesity at age 2 years. Two recent systematic reviews [12,13] highlight the inconsistency of research whilst demonstrating the importance of controlling for maternal prepregnancy BMI In both reviews, the association between maternal diabetes and childhood obesity was attenuated when maternal BMI was accounted for in the analysis. This study examines the effect of diabetes in pregnancy on offspring weight at birth and ages 1 and 5 years
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