Abstract
Aims/hypothesisThis study aimed to explore the infancy growth trajectories of ‘recent’ and ‘earlier’ offspring of mothers with gestational diabetes mellitus (OGDM), each compared with the same control infants, and investigate whether ‘recent’ OGDM still exhibit a classical phenotype, with macrosomia and increased adiposity.MethodsWithin a prospective observational birth cohort, 98 ‘earlier’ OGDM born between 2001 and 2009 were identified using 75 g oral glucose tolerance testing at 28 weeks gestation, 122 recent OGDM born between 2011 and 2013 were recruited postnatally through antenatal diabetes clinics, and 876 normal birthweight infants of mothers with no history of diabetes were recruited across the full study period as the control group. All infants followed the same study protocol (measurements at birth, 3, 12 and 24 months, including weight, length and skinfold thickness indicating adiposity, and detailed demographic data). In all cases, GDM was defined using the International Association of Diabetes and Pregnancy Study Group criteria.ResultsEarlier OGDM had higher birthweight SD scores (SDS) than control infants. Conversely, recent OGDM had similar birthweight- and length SDS to control infants (mean ± SD, 0.1 ± 1.0 and− 0.1 ± 0.9, respectively), but lower mean skinfold thickness SDS (−0.4 ± 0.6 vs 0.0 ± 0.9; p < 0.001). After birth, earlier OGDM showed reduced gains in weight and length between 3 and 12 months. In contrast, recent OGDM had increased weight and skinfold thickness gains until 3 months, followed by reduced gains in those variables from 3 to 12 months, compared with control infants. At 24 months, recent OGDM had lower adiposity than control infants (mean skinfold thickness SDS −0.3 ± 0.7 vs 0.0 ± 0.8; p < 0.001). At all time points recent OGDM had lower growth measurements than earlier OGDM.Conclusions/interpretationRecent OGDM showed different growth trajectories to the earlier group, namely normalisation of birthweight and reduced adiposity at birth, followed by initial rapid weight gain but subsequent reduced adiposity postnatally. While avoidance of macrosomia at birth may be advantageous, the longer-term health implications of these changing growth trajectories are uncertain.
Highlights
Offspring of gestational diabetic mothers (OGDM) are at increased risk of macrosomia [1] and higher newborn adiposity [2]
For the purpose of the current analyses, the same IADPSG criteria were retrospectively applied both to those OGTT collected as part of research between 2001 and 2009 and to those carried out as part of the clinical diagnostic procedures between 2011 and 2013 in order to reduce any bias in severity of gestational diabetes mellitus (GDM) resulting from changing diagnostic criteria over this period
Weight and length SD scores (SDS) for recent OGDM became comparable with that of control infants only at 24 months, reflecting increased growth between 12 and 24 months. Their skinfold thickness remained lower than that of control infants even at 24 months (Fig. 1). This observational study demonstrates significant differences in both birth size and subsequent infancy growth trajectories between recent and earlier OGDM compared with control infants
Summary
Offspring of gestational diabetic mothers (OGDM) are at increased risk of macrosomia [1] and higher newborn adiposity [2] These physical traits are associated with obstetric and neonatal complications, including prematurity, shoulder dystocia, hypoglycaemia and jaundice [3]. In recent years, some studies suggest that birth size of OGDM may be normalising [10, 11] This could be attributed to the changing diagnostic criteria for gestational diabetes mellitus (GDM) and subsequent more intensive management of gestational hyperglycaemia. In 2010, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) suggested more stringent GDM diagnostic criteria than those used previously [12]. As well as large birthweight, low birthweight and rapid postnatal ‘catch-up’ growth may have implications for future health [18]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
