Maternal glycemia during pregnancy and offspring abdominal adiposity measured by MRI in the neonatal period and preschool years: The Growing Up in Singapore Towards healthy Outcomes (GUSTO) prospective mother-offspring birth cohort study

Abstract

Background: Gestational diabetes is associated with unfavorable body fat distribution in offspring. However, less is known about the effects across the range of maternal gestational glycemia on offspring abdominal adiposity (AA) in infancy and early childhood.

Objectives: This study determined the association between gestational glycemia and offspring AA measured by MRI in the neonatal period and during the preschool years.

Methods: Participants were mother-offspring pairs from the GUSTO (Growing Up in Singapore Towards healthy Outcomes) prospective cohort study. Children who underwent MRI within 2 wk postdelivery (n = 305) and/or at preschool age, 4.5 y (n = 273), and whose mothers had a 2-h 75-g oral-glucose-tolerance test (OGTT) at 26-28 weeks of gestation were included. AA measured by adipose tissue compartment volumes-abdominal superficial (sSAT), deep subcutaneous (dSAT), and internal (IAT) adipose tissue-was quantified from MRI images.

Results: Adjusting for potential confounders including maternal prepregnancy BMI, each 1-mmol/L increase in maternal fasting glucose was associated with higher SD scores for sSAT (0.66; 95% CI: 0.45, 0.86), dSAT (0.65; 95% CI: 0.44, 0.87), and IAT (0.64; 95% CI: 0.42, 0.86) in neonates. Similarly, each 1-mmol/L increase in 2-h OGTT glucose was associated with higher neonatal sSAT (0.11; 95% CI: 0.03, 0.19) and dSAT (0.09; 95% CI: 0.00, 0.17). These associations were stronger in female neonates but only persisted in girls between fasting glucose, and sSAT and dSAT at 4.5 y.

Conclusions: A positive association between maternal glycemia and neonatal AA was observed across the whole range of maternal mid-gestation glucose concentrations. These findings may lend further support to efforts toward optimizing maternal hyperglycemia during pregnancy. The study also provides suggestive evidence on sex differences in the impact of maternal glycemia, which merits further confirmation in other studies.This trial was registered at clinicaltrials.gov as NCT01174875.

Keywords: early infancy; maternal glucose; mid-gestation; offspring abdominal adipose tissue compartment; pediatrics.

Copyright © The Author(s) 2020.

Figures

FIGURE 1

Scatterplots of abdominal adipose tissue compartment volumes in relation to maternal mid-gestation glucose concentrations stratified by sex. (A) Associations between maternal FPG concentrations and neonatal adipose tissue compartment volumes stratified by sex. P values for interaction between maternal mid-gestation FPG concentrations and sex on neonatal adipose tissue compartment volumes were 0.004, 0.037, and 0.003 for sSAT, dSAT, and IAT, respectively. The slope differences SD scores (95% CIs) are −0.59 (−0.99, −0.19) for sSAT, −0.45 (−0.88, −0.03) for dSAT, and −0.33 (−0.78, 0.11) for IAT. (B) Associations between maternal 2-h OGTT glucose concentrations and neonatal adipose tissue compartment volumes stratified by sex. P values for interaction between maternal mid-gestation 2-h OGTT glucose concentrations and sex on neonatal adipose tissue compartment volumes were 0.003, 0.075, and 0.017 for sSAT, dSAT, and IAT, respectively. The slope differences SD scores (95% CIs) are −0.23 (−0.38, −0.08) for sSAT, −0.15 (−0.31, 0.02) for dSAT, and −0.20 (−0.36, −0.04) SD for IAT. dSAT, abdominal deep subcutaneous adipose tissue; FPG, fasting plasma glucose; IAT, abdominal internal adipose tissue; OGTT, oral-glucose-tolerance test; sSAT, abdominal superficial subcutaneous adipose tissue.

FIGURE 2

Original abdominal water-suppressed MRI images (left column) and segmented images (right column) at the neonatal period and preschool years. In the segmented images, each abdominal adipose tissue compartment is color-coded: red denotes the superficial subcutaneous tissue, green denotes the deep subcutaneous tissue, and blue denotes the IAT at neonatal period and VAT at preschool years. There was a substantial increase in abdominal adipose tissue for all 3 compartments during the preschool years compared with the neonatal period. At the neonatal period (A, B), the intra-peritoneal fat within the IAT such as mesenteric fat (fat around the intestines, liver, and pancreas) was minimal compared with retro-peritoneal fat but it increased substantially during the preschool years (C, D); it is indicated by a yellow arrow. IAT, abdominal internal adipose tissue; VAT, visceral adipose tissue.