Maternal Gestational Diabetes Mellitus Research Articles

Early pregnancy vitamin D and the risk of adverse maternal and infant outcomes: a retrospective cohort study

BackgroundPrevious evidence has suggested that lower gestational vitamin D levels might increase the risks of adverse pregnancy and birth outcomes. The results remain inconsistent and require further exploration.MethodsA total of 2814 Chinese mother-infant pairs were included in this retrospective cohort study. Serum concentrations of 25(OH)D were reviewed in early pregnancy (16.3 ± 2.3 weeks). Outcomes of maternal gestational diabetes mellitus (GDM), cesarean section, fetal distress, preterm birth, low birth weight (LBW), and macrosomia were extracted from the medical records. Cox regression analysis was used to explore these associations.ResultsIn total, 19.3% of mothers were pregnant at an advanced age (≥35 years), and 40.3% of pregnant women had vitamin D deficiency (< 50 nmol/L). After adjusting for potential covariates, the hazard ratio (HR) (95% CI) per standard deviation (SD) increase of serum 25(OH)D concentrations was 0.86 (0.779, 0.951) for GDM, 0.844 (0.730, 0.976) for preterm birth, and 0.849 (0.726, 0.993) for LBW. Similar protective associations were found for GDM, cesarean section, and preterm birth for a better vitamin D status when compared with vitamin D deficiency.ConclusionHigher early pregnancy vitamin D was associated with a lower risk of GDM, cesarean section, preterm birth, and LBW.

Exposure to elevated per- and polyfluoroalkyl substances in early pregnancy is related to increased risk of gestational diabetes mellitus: A nested case-control study in Shanghai, China

BackgroundLong-chain per- and polyfluoroalkyl substances (PFASs) and their short-chain alternatives have been produced and used extensively in China. However, it is unclear whether these compounds contribute to the risk of gestational diabetes mellitus (GDM) in women residing in contaminated areas. ObjectiveThe study was performed to explore the association between PFASs varying in chain length and the risk of developing GDM. MethodA nested case-control study was conducted in a prospective cohort of 2,460 pregnant women between July 1, 2017, and January 31, 2019 in Shanghai, China. Twelve PFASs of interest were measured using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC-Q/TOF MS) in the sera of pregnant women at 16–20 weeks. GDM was diagnosed by an oral glucose tolerance test administered over 24–28 gestational weeks. The cases and controls were matched by maternal age. The relationship between maternal serum PFAS level and GDM risk was determined by conditional logistic and linear regression analyses. ResultsA total of 165 GDM cases and 330 controls were enrolled in the study cohort. The frequencies of detection of PFHpA, PFDS, and PFOSA were all ≤80%. Hence, they were excluded from any further risk analysis. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were detected at relatively high serum levels (medians 6.57 ng/mL and 8.07 ng/mL, respectively). The serum levels of perfluorobutanesulfonic acid (PFBS) and perfluorododecanoic acid (PFDoA) were significantly higher in the GDM group than they were in the control group (P = 0.02 and P < 0.01, respectively) according to a nonparametric Wilcoxon rank sum test. A quartile analysis showed that the odds ratio of GDM would significantly increase at the highest PFBS and PFDoA levels. In the core model, the adjusted ORs were 2.02 (95% CI = 1.04–3.79) and 13.00 (95% CI = 4.74–24.59), respectively, after adjusting for maternal age, sampling time, parity and body mass index [BMI]). ConclusionElevated maternal serum PFBS and PFDoA levels in early pregnancy may be associated with a substantially higher GDM risk.

Assessment of Correlations Between Neonatal Jaundice and Phototherapy With Childhood Diabetes Type 1

Previous investigations have indicated an association between modulation of developing the immune system with increased risk of autoimmune diseases such as type 1 Diabetes Mellitus (T1DM). Objectives: In the present study, we aimed to evaluate correlations between the positive history of blood group incompatibility, neonatal jaundice, and phototherapy with childhood type 1 DM. A case-control retrospective study was carried out in an Iranian Hospital in 2015. One-hundred subjects aged 1-15 years with T1DM were included as the case group. One-hundred healthy children were also considered as the control group. A questionnaire composed of demographic-clinical data was completed for each subject. Correlations between childhood type 1diabetes and some clinical risk factors were determined. One hundred cases with type 1 diabetes and 100 healthy control children entered the study. A significant association between maternal gestational diabetes mellitus and childhood T1DM was observed (P=0.05, OR=3.789). The history of neonatal jaundice in the case group was significantly higher than in the control group (P=0.02, OR=4.667). ABO incompatibilities in the case group were associated with 19 neonates with blood group A and 2 neonates with blood group B (mothers' blood group; O) (P=0.005, OR=7.397). In the case group, 29 of 38 cases with a history of jaundice had received phototherapy while in the control group, 19 participants had undergone phototherapy (P=0.126, OR=1.707). Results have indicated that neonatal Jaundice and ABO incompatibility could increase the risk of childhood T1DM. Moreover, maternal GDM should be considered as an increased subsequent risk of childhood T1D.

Influences of Maternal Prepregnancy Obesity and Gestational Diabetes Mellitus on the Infant Gut Microbiome in Full-Term Infants.

The Journal of Perinatal & Neonatal Nursing: July/September 2020 - Volume 34 - Issue 3 - p E20 doi: 10.1097/JPN.0000000000000512

Influences of Maternal Prepregnancy Obesity and Gestational Diabetes Mellitus on the Infant Gut Microbiome in Full-Term Infants

This review examines the current evidence of how prepregnancy obesity (PPO) and gestational diabetes mellitus (GDM) influence the newborn gut microbiome. Scientific gaps in the literature are described to guide future research in this area. The prevalence of PPO and GDM increased to 64% in the United States over the past decade. Prepregnancy obesity and GDM influence newborn gut microbiome and contribute to adverse short- and long-term outcomes in full-term infants. This review aims to discuss current research findings related to the associations between PPO and GDM, separately, and together, on infant gut microbiome outcomes, provide an overview of short-term and long-term outcomes, describe clinical relevance, and identify avenues for future scientific inquiry. This review found that PPO and GDM influence infant gut microbiomes. Infants born to women with PPO and GDM were found to have lower levels of diversity in gut microbiota than infants born to normal prepregnancy weight women and those born to women without GDM.

Association between maternal lipid profile and gestational diabetes mellitus

Association between maternal lipid profile and gestational diabetes mellitus

Maternal asthma and gestational diabetes mellitus: Exploration of potential associations.

Asthma and gestational diabetes mellitus are prevalent during pregnancy and associated with adverse perinatal outcomes. The risk of gestational diabetes mellitus is increased with asthma, and more severe asthma; yet, the underlying mechanisms are unknown. This review examines existing literature to explore possible links. Asthma and gestational diabetes mellitus are associated with obesity, excess gestational weight gain, altered adipokine levels and low vitamin D levels; yet, it's unclear if these underpin the gestational diabetes mellitus-asthma association. Active antenatal asthma management reportedly mitigates asthma-associated gestational diabetes mellitus risk. However, mechanistic studies are lacking. Existing research suggests asthma management during pregnancy influences gestational diabetes mellitus risk; this may have important implications for future antenatal strategies to improve maternal-fetal outcomes by addressing both conditions. Addressing shared risk factors, as part of antenatal care, may also improve outcomes. Finally, mechanistic studies, to establish the underlying pathophysiology linking asthma and gestational diabetes mellitus, could uncover new treatment approaches to optimise maternal and child health outcomes.

Effects of Maternal Obesity and Gestational Diabetes Mellitus on the Placenta: Current Knowledge and Targets for Therapeutic Interventions.

Obesity and gestational diabetes mellitus (GDM) are becoming more common among pregnant women worldwide and are individually associated with a number of placenta-mediated obstetric complications, including preeclampsia, macrosomia, intrauterine growth restriction and stillbirth. The placenta serves several functions throughout pregnancy and is the main exchange site for the transfer of nutrients and gas from mother to fetus. In pregnancies complicated by maternal obesity or GDM, the placenta is exposed to environmental changes, such as increased inflammation and oxidative stress, dyslipidemia, and altered hormone levels. These changes can affect placental development and function and lead to abnormal fetal growth and development as well as metabolic and cardiovascular abnormalities in the offspring. This review aims to summarize current knowledge on the effects of obesity and GDM on placental development and function. Understanding these processes is key in developing therapeutic interventions with the goal of mitigating these effects and preventing future cardiovascular and metabolic pathology in subsequent generations.

Stromal Cell-Derived Factor (SDF) 2 and the Endoplasmic Reticulum Stress Response of Trophoblast Cells in Gestational Diabetes Mellitus and In vitro Hyperglycaemic Condition.

The endoplasmic reticulum (ER) stress response and the unfolded protein response (UPR) are essential cellular mechanisms to ensure the proper functioning of ER in adverse conditions. However, activation of these pathways has also been associated with insulin resistance and cell death in pathological conditions such as diabetes mellitus. In the present study, we investigated whether stromal cell-derived factor 2 (SDF2)-an ER stress-responsive factor-is related to ER response in placental cells exposed to maternal gestational diabetes mellitus (GDM) or to a hyperglycaemic in vitro condition. The study aimed to investigate the role of SDF2 in BeWo cells , a trophoblast cell line originating from choriocarcinoma , and in placental tissue under hyperglycaemic conditions. Protein levels of SDF2 and UPR factors, glucose-related protein 78 (GRP78) and eukaryotic initiation factor 2 alpha (elF2 alpha) were evaluated in the placentae of pregnant women diagnosed with GDM and treated by diet-control (insulin was added when necessary). The mRNA expression of SDF2 and UPR factors CHOP and sXBP1 were assessed in cultured BeWo cells challenged with glucose and treated with or without insulin. SDF2 expression was increased in the placentae of GDM women treated with diet. However, its values were similar to those of normoglycemic controls when the GDM women were treated with insulin and diet. BeWo cells cultured with high glucose and insulin showed decreased SDF2 expression, while high glucose increased CHOP and sXBP1 expression, which was then significantly reverted with insulin treatment. Our findings extend the understanding of ER stress and SDF2 expression in placentae exposed to hyperglycaemia, highlighting the relevance of insulin in reducing the levels of ER stress factors in placental cells. Understanding the effect of ER stress partners such as SDF2 on signalling pathways involved in gestation, complicated by hyperglycaemia, is pivotal for basic biomedical research and may lead to new therapeutic possibilities.

Cell Type- and Sex-Specific Dysregulation of Thyroid Hormone Receptors in Placentas in Gestational Diabetes Mellitus

Thyroid hormones are essential for development of trophoblasts and the fetus. They also regulate a wide range of metabolic processes. We investigated the influence of maternal gestational diabetes mellitus (GDM) on thyroid hormone receptor (THR) isoforms THRα1, THRα2, THRβ1 and THRβ2 of the human placenta in a sex- and cell-type specific manner. Term placental tissue was obtained from women with (n = 40) or without GDM (control; n = 40). THRs levels were measured by semi-quantitative immunohistochemistry and real-time qRT-PCR. We localized THR immunostaining in syncytiotrophoblast (SCT), which was the tissue with the strongest signal. Double immunofluorescence identified THR in decidual cells in the stroma and in extravillous cytotrophoblasts. GDM did not change THRα1 immunolabelling intensity in decidua, but was associated with a stronger immunolabelling in SCT compared to GDM (p < 0.05). The SCT difference of GDM vs. control was strongest (p < 0.01) in female placentas. THRα2 was only weakly present and immunolabelling was weaker (p < 0.05) in SCT of only male GDM placentas in comparison to male controls. THRβ1/β2 immunostaining was weak in all cell types without changes in GDM. However, more THRβ1/2 protein was present (p < 0.001) in male than female placentas. All these protein changes were paralleled by changes of THR transcript levels. The data show that THR are expressed in term trophoblast in relation to fetal sex. Maternal GDM influences predominantly THRα1 in SCT, with the strongest GDM effect in SCT of female placentas.

Associations Between Exposure to Gestational Diabetes Mellitus In Utero and Daily Energy Intake, Brain Responses to Food Cues, and Adiposity in Children.

OBJECTIVEChildren exposed to gestational diabetes mellitus (GDM) or maternal obesity in utero have an increased propensity to develop obesity. Little is known about the mechanisms underlying this phenomenon. We aimed to examine relationships between exposure to GDM or maternal obesity and daily energy intake (EI), brain responses to food cues within reward regions, and adiposity in children.RESEARCH DESIGN AND METHODSParticipants were 159 children ages 7–11 years. Repeated 24-h recalls were conducted to assess mean daily EI. A subset of children (n = 102) completed a food cue task in the MRI scanner. A priori regions of interest included the orbital frontal cortex (OFC), insula, amygdala, ventral striatum, and dorsal striatum. Adiposity measurements, BMI z-scores, percent body fat, waist-to-height ratio (WtHR), and waist-to-hip ratio (WHR) were assessed.RESULTSExposure to GDM was associated with greater daily EI, and children exposed to GDM diagnosed before 26 weeks gestation had greater OFC food cue reactivity. Children exposed to GDM also had larger WHR. Results remained significant after adjusting for child’s age and sex, maternal education and race/ethnicity, maternal prepregnancy BMI, and child’s physical activity levels. Furthermore, children who consumed more daily calories had greater WHR, and the relationship between GDM exposure and WHR was attenuated after adjustment for daily EI. Prepregnancy BMI was not significantly related to daily EI or food cue reactivity in reward regions. However, prepregnancy BMI was significantly related to all adiposity measurements; results remained significant for BMI z-scores, WtHR, and WHR after controlling for child’s age and sex, maternal education and race/ethnicity, maternal GDM exposure, and child’s physical activity levels.CONCLUSIONSExposure to GDM in utero, in particular before 26 weeks gestation, is associated with increased EI, enhanced OFC food cue reactivity, and increased WHR. Future study with longitudinal follow-up is merited to assess potential pathways of daily EI and food cue reactivity in reward regions on the associations between GDM exposure and childhood adiposity.

Increased risk of gestational diabetes mellitus in women with higher prepregnancy ambient PM2.5 exposure

BackgroundAir pollution is a serious environmental problem in China. This study was designed to investigate whether exposure to particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM2.5) before pregnancy is associated with gestational diabetes mellitus (GDM) and fasting glucose in China. MethodsWe recruited subjects and collected clinical data from the Nanjing Maternity and Child Health Care Hospital from July 2016 to October 2017. A series of validated land-use regression (LUR) models were built to assess individual exposure to PM2.5 in a 1 × 1 km area at both work and home addresses following a time-weighted pattern. Multiple linear regression and logistic regression analyses were performed to examine the association between PM2.5 exposure and GDM and fasting glucose. ResultsIn total, 11,639 of 16,995 women were included in the final analysis. Among the 11,639 women, 2776 (23.85%) had GDM. Individual exposure to PM2.5 within three months before pregnancy ranged from 21.58 to 85.92 μg/m3. Positive associations were observed among the interquartile ranges (IQRs) of exposure to PM2.5 within three months before pregnancy and GDM (OR = 2.61, 95% CI: 1.40–4.93, p < .01) as well as fasting glucose levels (β = 0.57, 95% CI: 0.45–0.68, p < .01). The diabetogenic effects of PM2.5 gradually increased from the first month before pregnancy, peaked in the second month and then gradually decreased until the third month when the week-specific exposure were analyzed to identify the sensitive time window. ConclusionOur study confirmed that higher exposure to PM2.5 within three months before pregnancy is significantly associated with increased risk of GDM and elevated fasting glucose levels, reflecting the importance of preconceptional environmental exposure in the development of maternal GDM.

Associations of exposure to fine particulate matter during pregnancy with maternal blood glucose levels and gestational diabetes mellitus: Potential effect modification by ABO blood group.

Previous studies have examined the relationships between prenatal fine particulate matter (PM2.5) exposure and gestational diabetes mellitus (GDM), but the results were inconsistent. Furthermore, the possible effect modification by ABO blood group has not been explored. To assess the associations of PM2.5 exposures during pregnancy with maternal glucose levels as well as GDM, and further to evaluate the potential effect modification by ABO blood group. Between January 2013 and January 2015, 4783 pregnant women were enrolled in our study based on a birth cohort in Wuhan. Daily PM2.5 exposure levels for each woman during pregnancy were estimated using a spatial-temporal land-use regression model. Linear regressions with general estimating equations (GEE) were performed to assess the associations between trimester-specific PM2.5 exposures and maternal glucose levels. Modified Poisson regressions with GEE analyses were used to evaluate the impacts of PM2.5 exposures during each trimester on the risk of GDM. The associations of PM2.5 exposure during the whole study period with glucose levels and GDM were estimated using multiple linear regression model and modified Poisson regression model, respectively. We conducted a stratified analysis to explore the potential effect modification by ABO blood group. Among all the 4783 participants, 394 (8.24%) had GDM. Exposure to PM2.5 was found to be positively associated with elevated fasting glucose level during the whole study period [0.382mg/dL, 95% confidence interval (CI): 0.179-0.586, per 10μg/m3 increase in PM2.5], the first trimester (0.154mg/dL ,95% CI: 0.017-0.291) and the second trimester (0.541mg/dL, 95% CI: 0.390-0.692). No statistically significant results were observed between PM2.5 and 1-h and 2-h glucose levels during any study period. Increased risks of GDM for each 10μg/m3 increase in PM2.5 levels were observed during the whole study period [relative risk (RR): 1.120, 95% CI: 1.021-1.228] and the first trimester (RR: 1.074, 95% CI: 1.012-1.141), but not the second trimester (RR: 1.035, 95% CI: 0.969-1.106). Stratified analysis indicated that the associations of PM2.5 exposures with GDM were more pronounced among pregnant women with blood group A, but no significant effect modifications were observed. Our study enriched epidemiological evidence linking PM2.5 exposures during pregnancy to elevated maternal glucose levels and increased risk of GDM. More importantly, we first highlighted that the impact of PM2.5 on GDM might be greater among pregnant women with blood group A.

Elevated First-Trimester Neutrophil Count Is Closely Associated With the Development of Maternal Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes.

Chronic low-grade inflammation plays a central role in the pathophysiology of gestational diabetes mellitus (GDM). To investigate the ability of different inflammatory blood cell parameters in predicting the development of GDM and pregnancy outcomes, 258 women with GDM and 1,154 women without were included in this retrospective study. First-trimester neutrophil count outperformed white blood cell count and the neutrophil-to-lymphocyte ratio in the predictability for GDM. Subjects were grouped based on tertiles of neutrophil count during their first-trimester pregnancy. The results showed that as the neutrophil count increased, there was a stepwise increase in GDM incidence as well as in glucose and glycosylated hemoglobin levels, HOMA for insulin resistance (HOMA-IR), macrosomia incidence, and newborn weight. Neutrophil count was positively associated with prepregnancy BMI, HOMA-IR, and newborn weight. Additionally, neutrophil count was an independent risk factor for the development of GDM, regardless of the history of GDM. Spline regression showed that there was a significant linear association between GDM incidence and the continuous neutrophil count when it was >5.0 × 109/L. This work suggested that the first-trimester neutrophil count is closely associated with the development of GDM and adverse pregnancy outcomes.

Contributions of Prenatal Exposures and Child Lifestyle to Insulin Sensitivity.

Prenatal exposures and lifestyle factors are important for metabolic health. Determine how prenatal exposures to maternal obesity and/or gestational diabetes mellitus (GDM) and childhood lifestyle factors independently contribute to child insulin sensitivity. Ninety children aged 7 to 11 years (56% girls, 60% exposed to GDM), born at Kaiser-Permanente Southern California, completed an oral glucose tolerance test (OGTT) as part of the BrainChild Study. Matsuda insulin sensitivity index (ISI) was used to estimate insulin sensitivity. Participants completed two 24-hour dietary recalls, and daily energy intake (EI), dietary added sugar, and total sugar were calculated. The 3-day physical activity recall determined the average minutes per day of moderate to vigorous physical activity (MVPA) and the average minutes per day spent sedentary. Maternal prepregnancy body mass index (BMI) and GDM status were extracted from electronic medical records. Matsuda-ISI. Linear regression showed that children who spent more time in MVPA had better ISI (β = 0.33; P = 0.001), and results remained after adjustment for maternal prepregnancy BMI, GDM exposure, child age, sex, daily EI, dietary added sugar (β = 0.34; P = 0.001), and further adjustment for child adiposity (β = 0.29; P = 0.001). Time spent sedentary, maternal prepregnancy BMI, GDM exposure, dietary added sugar, total sugar, and EI were not associated with ISI. Physical activity was the only predictor of ISI at this age, suggesting that engaging in physical activity during childhood is beneficial for insulin sensitivity and may ameliorate future risk for metabolic disease.

Adverse maternal and neonatal outcomes in pregnant women with abnormal glucose metabolism

AimsTo assess the prevalence and risk of adverse perinatal outcomes in pregnant women with abnormal glucose metabolism. Methods3269 Chinese pregnant women with singleton delivery were studied, including 787 diagnosed as gestational diabetes mellitus (GDM), 115 pregnancy with diabetes (PWD), and 2367 normal glucose tolerance (NGT). The prevalence and risk of adverse maternal and fetal outcomes were compared and assessed among the three groups, and the related risk factors of the glucose metabolism for adverse pregnancy outcomes were evaluated by binary logistic regression. ResultsCompared to NGT, maternal GDM and PWD faced increased risk of adverse perinatal outcomes such as pregnancy-induced hypertension (odds ratio (OR) 1.78 [95% confidence interval (CI): 1.17–2.72]; 4.31 [95% CI: 2.32–7.98]), low birth weight (OR 1.51 [95% CI: 1.01–2.28]; 4.05 [95% CI: 2.17–7.55]). And PWD group exhibited remarkably higher risk for preterm delivery (OR 2.88 [95% CI: 1.68–4.94]) and stillbirth (OR 7.78 [95% CI: 2.44–24.84]) than other two groups. The increased fasting insulin and glycated hemoglobin A1c were successively independent risk factors for maternal and neonatal adverse outcomes. ConclusionsGestational abnormal glucose metabolism is associated with the remarkably increased risk of adverse perinatal outcomes, and PWD has higher risk of adverse perinatal outcomes than GDM.

Neonatal Polycythemia and Hypoglycemia in Newborns: Are They Related?

This study aimed to test whether neonatal hypoglycemia (NH) is more common in infants with neonatal polycythemia (NP). This is a retrospective study based on universal screening of NH and targeted screening for NP. Polycythemia was defined as venous hematocrit ≥ 65%. NH was defined as whole blood glucose (BG) concentration < 48 mg/dL (measured using a "point-of-care" analyzer [Accu-Chek]). The study population consisted of 119 consecutive term polycythemic infants and 117 controls. There were no significant differences between the two groups in perinatal characteristics, minimal BG concentration, and rate of hypoglycemia. In a stepwise backward multiple regression where NH was the dependent variable, only maternal gestational diabetes mellitus (p = 0.032) and toxemia (p = 0.001) remained significant, whereas NP was insignificant. NH is not more common in NP infants than in non-NP infants. We suggest that the occurrence of NH in infants with NP might be related to the common risk factors of the two morbidities.

Down-regulation of the insulin signaling pathway by SHC may correlate with congenital heart disease in Chinese populations.

Congenital heart disease (CHD) is one of the most common and severe congenital defects. The incidence of fetal cardiac malformation is increased in the context of maternal gestational diabetes mellitus (GDM). Therefore, we wanted to determine whether abnormalities in the insulin signaling pathway are associated with the occurrence of nonsyndromic CHD (ns-CHD). We used digital gene expression profiling (DGE) of right atrial myocardial tissue samples from eight ns-CHD patients and four controls. The genes potentially associated with CHD were validated by real-time fluorescence quantitative PCR analysis of right atrial myocardial tissues from 37 patients and 10 controls and the H9C2 cell line. The results showed that the insulin signaling pathway, which is mediated by the SHC gene family, was inhibited in the ns-CHD patients. The expression levels of five genes (PTPRF, SHC4, MAP2K2, MKNK2, and ELK1) in the pathway were significantly down-regulated in the patients' atrial tissues (P<0.05 for all). In vitro, the H9C2 cells cultured in high glucose (33 mmol/l) expressed less SHC4, MAP2K2, and Elk-1 than those cultured in low glucose (25 mmol/l). Furthermore, the high glucose concentration down-regulated the 25 genes associated with blood vessel development based on Gene Ontology (GO) term enrichment analyses of RNA-seq data. We considered that changes in the insulin signaling pathway mediated by SHC might be involved in the heart development process. This mechanism might account for the increase in the incidence of fetal cardiac malformations in the context of GDM.

Adverse pregnancy outcomes on the risk of overweight offspring: a population-based retrospective study in Xiamen, China

The growth trajectory of Chinese preschoolers still remains unclear. Our objective was to determine whether there was an association between adverse pregnancy outcomes and overweight offspring. We analyzed population-based retrospective cohort data from the Medical Birth Registry of Xiamen, which comprised 33,157 children examined from 1 to 6 years of age. Longitudinal analyses were used to evaluate the growth trajectories of offspring body mass index (BMI). Multivariate logistic regression was used to assess the effects of two adverse pregnancy outcomes, gestational diabetes mellitus (GDM) and being large-for-gestational age (LGA), on childhood overweight. Offspring of mothers with GDM and LGA has a higher annual BMI z-score from 1 to 6 years of age (all P < 0.05). But, a higher annual BMI z-score was only observed in children aged 1–5 years in models 1–3. Overall BMI z-score of offspring aged 1–6 who were born to mothers with GDM and LGA were also higher in models 1–3 (all P < 0.05). Additionally, offspring of mothers with GDM and LGA had a higher risk for overweight in model 1, from 1 to 6 years of age (odds ratio (OR), 1.814; 95% confidence interval (CI), 1.657–1.985; P < 0.0001). However, this association was attenuated after adjusting for maternal pre-pregnancy BMI (OR, 1.270; 95% CI, 0.961–1.679; P = 0.0930). Offspring of mothers with GDM and LGA had a higher BMI z-score and increased risk for overweight. Indeed, intrauterine exposure to maternal GDM and LGA could bias offspring to overweight, whereas maternal pre-pregnancy BMI may play a key role in offspring overweight for children born to mothers with GDM and LGA.

In utero exposure to gestational diabetes mellitus and cardiovascular risk factors in youth: A longitudinal analysis in the EPOCH cohort.

To examine associations of maternal gestational diabetes mellitus (GDM) with offspring cardiovascular biomarkers from late childhood through adolescence. We used mixed effects linear regression models to examine associations of maternal GDM (n = 92 cases of 597) with average offspring levels of serum lipids (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides) and systolic blood pressure (SBP) across two research visits spanning approximately 10.6 and 16.9 years of age. In sex-stratified analysis, we evaluated the impact of adjustment for sociodemographic characteristics, pubertal status, physical activity and total energy intake, maternal body mass index (BMI), GDM treatment, and child's BMI. After adjusting for child's age, pubertal status, race/ethnicity, and maternal education and smoking, GDM exposure was associated with higher total (0.38 [95% CI, 0.16-0.61] mmol/L) and LDL cholesterol (0.34 [95% CI, 0.14-0.53] mmol/L) in girls. These estimates were robust to adjustment for lifestyle characteristics and maternal BMI but were attenuated after accounting for GDM treatment with no appreciable change following further adjustment for current BMI. In boys, maternal GDM corresponded with 4.50 (1.90-7.10) mmHg higher SBP. This association persisted after accounting for sociodemographic/lifestyle characteristics, maternal BMI, and GDM treatment but was attenuated after adjusting for current BMI. Maternal GDM is related to offspring lipid profile and SBP in a sex-specific manner.