Abstract
Exposure to maternal diabetes in utero increases the risk in the offspring for a range of metabolic disturbances. However, the timing and variability of in utero hyperglycemic exposure necessary to cause impairment have not been elucidated. The TEAM Study was initiated to evaluate young adult offspring of mothers with pregestational diabetes mellitus. This paper outlines the unique enrollment challenges of the TEAM Study and preliminary analysis of the association between exposure to diabetes in pregnancy and adverse metabolic outcomes. The TEAM Study enrolls offspring of women who participated in a Diabetes in Pregnancy (DiP) Program Project Grant between 1978 and 1995. The DiP Study collected medical and obstetric data across pregnancy. The first 96 eligible offspring of women with pregestational diabetes were age-, sex-, and race-matched to adults from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 with an OGTT. Descriptive and regression analyses were employed to compare TEAM participants to NHANES participants. Among a subset of TEAM participants, we compared the metabolic outcomes across maternal glucose profiles using a longitudinal data clustering technique that characterizes level and variability, in maternal glucose across pregnancy. By comparing categories of BMI, TEAM Study participants had over 2.0 times the odds of being obese compared to matched NHANES participants (for class III obesity, OR = 2.81; 95% confidence interval (CI): 1.15, 6.87). Increasing levels of two-hour glucose were also associated with in utero exposure to pregestational diabetes in matched analyses. Exposure to pregestational diabetes in utero may be associated with an increased risk of metabolic impairment in the offspring with clinical implications.
Highlights
Diabetes mellitus has reached epidemic proportions in the United States and around the world
Recruitment, enrollment, and study completion of the first 107 participants of the Transgenerational Effect on Adult Morbidity (TEAM) Study
We observed that adult offspring born to mothers with type 1 diabetes during pregnancy were more likely to be obese and have impaired glucose metabolism as indicated by elevated two-hour glucose compared to an age, sex, and race-matched cohort
Summary
Diabetes mellitus has reached epidemic proportions in the United States and around the world. In some counties in the United States, over 25% of the population has diabetes [1] and 35% of adults 20 years and older have prediabetes [2]. Exposure to maternal diabetes in utero increases the risk in the offspring for metabolic disturbances, including obesity [4,5,6,7], insulin resistance [8,9,10], type 2 diabetes mellitus [6, 11, 12], and cardiovascular (CV) dysfunction [13, 14]. In addition to metabolic consequences, offspring of mothers with diabetes may be at risk for cognitive and behavioral impairments [15, 16]
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