Metabolic profiling in infants of mothers with diabetes or hyperglycaemia during pregnancy

Abstract

regnancy-related diabetes is a growing public health concern, with up to 40000 cases in the UK each year. Intrauterine exposure to diabetes is associated with greater risks of adverse metabolic sequelae in later life. 1 Two recent meta-analyses examine the relationship between maternal diabetes in pregnancy and offspring BMI and blood pressure in childhood. Offspring of mothers with diabetes had 0.28kg/m 2 higher mean BMI and 1.88mmHg greater systolic BP compared to controls. 2,3 These differences may have important clinical implications. 4,5 Maternal diabetes is also associated with an increased risk of glucose intolerance and type 2 diabetes (T2D) in offspring. 6,7 These risks are elevated in both preexisting and gestational diabetes and are independent of the effects of maternal obesity. 1,8,9 Risks are also additional to genetic predisposition. The comparison of siblings born before and after their mother develops diabetes provides particularly compelling evidence as this minimises the possible impact of genetic and environmental influences, but examines the effect of intrauterine exposure to diabetes. In the Pima Indian population, children born after their mother developed diabetes were shown to have higher systolic BP, HbA1c, BMI and nearly four times the odds of developing T2D compared to siblings born before their mother developed diabetes. 10,11 In a large prospective Swedish study, young men whose mothers had diabetes during pregnancy had on average 0.94kg/m 2 greater BMI than brothers born before their mother developed diabetes. 12 An altered phenotype is also evident in off