Gestational diabetes mellitus and the offspring--Jack and Jill are different still.

Abstract

Hyperglycemia is the most common metabolic disorder complicating pregnancies across the globe. With rising maternal age, obesity, physical inactivity (1), and increasingly stringent diagnostic criteria, about one in seven women now has a pregnancy complicated by hyperglycemia (2). The Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) confirmed that treating women with gestational diabetes mellitus (GDM) reduces serious perinatal complications (infant death, shoulder dystocia, fracture and nerve palsy) (3). Likewise, a trial by Landon et al. (4) showed that treating women with hyperglycemia reduces maternal weight gain, gestational hypertension, preeclampsia, cesarean delivery, infant adiposity, and birth weight. Of note, the degree of glycemia in the Landon et al. trial was comparatively less than that in ACHOIS, as suggested by only 8% of women in the intervention arm requiring insulin therapy compared with 20% in ACHOIS. A secondary analysis in a subgroup of offspring in the original Landon et al. trial showed that male offspring had a lower birth weight percentile and fat mass and gained greater benefit from the maternal GDM intervention compared with female offspring (5). These landmark trials have changed the clinical practice of GDM, placing greater emphasis on glucose-lowering interventions to reduce obstetric and perinatal complications. Emerging evidence suggests that the intrauterine and early postnatal environment can influence cardiovascular and metabolic health in later life. Maternal hyperglycemia in GDM is thought to confer a greater risk of diabetes and obesity in exposed offspring via fetal programming. Animal models suggest similar associations but are hampered by …