Abstract
Objectives: Either maternal gestational diabetes mellitus (GDM) or hypertensive disorder of pregnancy (HDP) is associated with an increased risk of obesity in the offspring. However, their joint associations with obesity in offspring remain unclear. We investigated the joint associations of maternal GDM and HDP with childhood overweight in offspring.Methods: We performed a large study in 1967 mother-child pairs. Maternal GDM was diagnosed according to the 1999 World Health Organization (WHO) criteria. HDP was defined as self-reported doctor-diagnosed hypertension or treatment of hypertension (including gestational hypertension, preeclampsia, sever preeclampsia or eclampsia) after 20 weeks of gestation on the questionnaire. Body mass index (BMI) for age Z-score and childhood overweight were evaluated according to WHO growth reference. We used the general linear models to compare children's Z score for BMI and logistic regression models to estimate odds ratios of childhood overweight according to maternal different status of GDM and HDP.Results: Offspring of mothers with both GDM and HDP had a higher BMI for age Z-score (0.63 vs. 0.03, P < 0.001) than children born to normotensive and normoglycemic pregnancy. After adjustment for maternal and children's major confounding factors, joint GDM and HDP were associated with increased odds ratios of offspring's overweight compared with normotensive and normoglycemic pregnancy (2.97, 95% confidence intervals [CIs] 1.65–5.34) and GDM alone (2.06, 95% CIs 1.20–3.54), respectively. After additional adjustment for maternal pre-pregnancy BMI and gestational weight gain, joint maternal GDM, and HDP was still associated with an increased risk of offspring's overweight compared with the maternal normotensive, and normoglycemic group but became to have a borderline increased risk compared with the maternal GDM alone group.Conclusions: Maternal GDM alone or joint GDM and HDP were associated with increased ratios of offspring's overweight.
Highlights
Children with overweight and obesity are more likely to be affected by obesity into adulthood and develop noncommunicable diseases including metabolic syndrome, cardiovascular diseases, and type 2 diabetes [1,2,3]
After further adjustment for children’s lifestyle factors, maternal pre-pregnancy Body mass index (BMI), and gestational weight gain, the difference of Z score for BMI was still significant among children who born to mothers with gestational diabetes mellitus (GDM) alone and concomitant GDM and hypertensive disorder of pregnancy (HDP), but no longer significant among children born to HDP pregnancy alone, compared with those born to normotensive and normoglycemic mothers during pregnancy
After additional adjustment for children’s lifestyle factors, maternal pre-pregnancy BMI, and gestational weight gain, children who born to mothers with GDM only or with both GDM and HDP still had significantly increased odds ratios of overweight compared with children who born to mothers with normotension and normoglycaemia during pregnancy (Model 2-3, Table 3)
Summary
Children with overweight and obesity are more likely to be affected by obesity into adulthood and develop noncommunicable diseases including metabolic syndrome, cardiovascular diseases, and type 2 diabetes [1,2,3]. Changes in children’s behaviors, such as unhealthy eating habit, lacking moderate-to-vigorous physical activity, and increasing sedentary time, mainly account for the increasing prevalence of childhood obesity [7,8,9] Other factors, such as genetic susceptibility, socioeconomic inequalities, maternal education, children’s sleep disturbance, neonatal macrosomia, may play an important role in obesity formation [8,9,10,11]. Recent studies have indicated that maternal metabolic disorders during pregnancy, such as gestational diabetes mellitus (GDM), and hypertensive disorder of pregnancy (HDP), were associated with an increased risk of obesity in children over 5 years old. A previous study from our team demonstrated that maternal HDP was a risk factor for childhood overweight or obesity in the offspring of mothers with GDM [21]. We aimed to examine the joint association of maternal GDM and HDP with children’s overweight among 1,967 mother-child pairs, including 1,263 mothers with GDM, and 704 without GDM
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