Abstract
Background Studies of developmental origins of health and disease have highlighted the possible role of intrauterine hyperglycaemia, increasing the future risk of obesity, diabetes, and cardiovascular diseases in the offspring. There is limited evidence from South Asian populations for risk estimates for childhood obesity that are attributable to maternal diabetes in utero. Objective The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and anthropometric parameters in the offspring at 10-11 years of age. Methods A community-based retrospective cohort study was conducted in Colombo district, Sri Lanka. In the first stage, children born in 2005 were identified, and the availability of antenatal records was assessed. In the second stage, the exposure status of participants was ascertained based on antenatal records and predefined criteria. In the third stage, height, weight, waist circumference, and triceps skinfold thickness (TSFT) of eligible participants were measured to ascertain the outcome status. Background characteristics were collected by interviewing mothers. A 24-hour dietary recall and a 3-day diet diary were recorded. Results 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (nonexposed) participated. Mean ages (SD) of exposed and unexposed groups were 10.9 (0.3) and 10.8 (0.3) years, respectively. The median BMI (17.6 vs 16.1, p < 0.001), waist circumference (63 cm vs 59.3 cm, p < 0.001), and triceps skinfold thickness (13.7 mm vs 11.2 mm, p < 0.001) were significantly higher in the exposed group. Offspring of women with HIP were more likely to be overweight (aOR = 2.6, 95% CI 1.4–4.9) and have abdominal obesity (aOR = 2.7, 95% CI 1.1–6.5) and high TSFT (aOR = 2.2, 95% CI 1.06–4.7) at 10-11 years than children who were not exposed after adjusting for maternal BMI, maternal age at delivery, and birth order. Conclusions Intrauterine exposure to HIP is a significant determinant of overweight, high TSFT, and abdominal obesity in the offspring.
Highlights
Hyperglycaemia in pregnancy (HIP) is one of the most common medical conditions encountered in pregnancy. e International Diabetes Federation (IDF) estimates that one in six live births (16.2%) in the world and one in four live births (24%) in South East Asia are complicated with some form of hyperglycemia in pregnancy [1]. e number of women having hyperglycaemia in pregnancy is increasing as a result of the increasing prevalence of obesity and diabetes in women and higher age at childbirth [2]
Frienkel and Metzger stated that Journal of Obesity deficiency of maternal insulin causes an increased influx of mixed nutrients or fuels into fetal circulation resulting in hyperinsulinaemia [3]
Metabolic changes in the intrauterine environment caused by different types of HIP appear to affect the growth of the developing foetus in a similar manner [7], and there is evidence that long-term consequences of intrauterine exposure to hyperglycaemia on the offspring are independent of mother’s diabetes type [8, 9]
Summary
Hyperglycaemia in pregnancy (HIP) is one of the most common medical conditions encountered in pregnancy. e International Diabetes Federation (IDF) estimates that one in six live births (16.2%) in the world and one in four live births (24%) in South East Asia are complicated with some form of hyperglycemia in pregnancy [1]. e number of women having hyperglycaemia in pregnancy is increasing as a result of the increasing prevalence of obesity and diabetes in women and higher age at childbirth [2].Pederson’s hyperglycemia-hyperinsulinism hypothesis, as supported by several studies, is still the basis of research on fetomaternal metabolism [3, 4]. is hypothesis postulates that deficiency of maternal insulin causes a rise in maternal glucose, which in turn increases fetal glucose levels.is results in fetal hyperinsulinaemia which stimulates fetal growth and adiposity. Journal of Obesity deficiency of maternal insulin causes an increased influx of mixed nutrients or fuels (glucose, amino acids, lipids, and ketones) into fetal circulation resulting in hyperinsulinaemia [3]. Metabolic changes in the intrauterine environment caused by different types of HIP appear to affect the growth of the developing foetus in a similar manner [7], and there is evidence that long-term consequences of intrauterine exposure to hyperglycaemia on the offspring are independent of mother’s diabetes type [8, 9]. Studies of developmental origins of health and disease have highlighted the possible role of intrauterine hyperglycaemia, increasing the future risk of obesity, diabetes, and cardiovascular diseases in the offspring.
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