Effect of treatment of gestational diabetes mellitus on obesity in the next generation

Matthew W Gillman, Helena Oakey, Peter A Baghurst, Robert E Volkmer, Jeffrey S Robinson, Caroline A Crowther, Matthew W Gillman, Helena Oakey, Peter A Baghurst, Robert E Volkmer, Jeffrey S Robinson, Caroline A Crowther

Abstract

Objective: Gestational diabetes mellitus (GDM) may cause obesity in the offspring. The objective was to assess the effect of treatment for mild GDM on the BMI of 4- to 5-year-old children.

Research design and methods: Participants were 199 mothers who participated in a randomized controlled trial of the treatment of mild GDM during pregnancy and their children. Trained nurses measured the height and weight of the children at preschool visits in a state-wide surveillance program in the state of South Australia. The main outcome measure was age- and sex-specific BMI Z score based on standards of the International Obesity Task Force.

Results: At birth, prevalence of macrosomia (birth weight >or=4,000 g) was 5.3% among the 94 children whose mothers were in the intervention group, and 21.9% among the 105 children in the routine care control group. At 4- to 5-years-old, mean (SD) BMI Z score was 0.49 (1.20) in intervention children and 0.41 (1.40) among controls. The difference between treatment groups was 0.08 (95% CI -0.29 to 0.44), an estimate minimally changed by adjustment for maternal race, parity, age, and socio-economic index (0.08 [-0.29 to 0.45]). Evaluating BMI >or=85th percentile rather than continuous BMI Z score gave similarly null results.

Conclusions: Although treatment of GDM substantially reduced macrosomia at birth, it did not result in a change in BMI at age 4- to 5-years-old.

Figures

Figure 1
Figure 1
Participants in a study assessing BMI among 4- to 5-year-old children whose mothers participated in a randomized controlled trial of treatment of mild gestational diabetes.

References

    1. Aerts L, Van Assche FA: Animal evidence for the transgenerational development of diabetes mellitus. Int J Biochem Cell Biol 2006; 38: 894– 903
    1. Plagemann A, Harder T, Dudenhausen JW: The diabetic pregnancy, macrosomia, and perinatal nutritional programming. Nestle Nutr Workshop Ser Pediatr Program 2008; 61: 91– 102
    1. Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047– 1053
    1. Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir MM, Roumain J, Bennett PH, Knowler WC: Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes 2000; 49: 2208– 2211
    1. Silverman BL, Rizzo T, Green OC, Cho NH, Winter RJ, Ogata ES, Richards GE, Metzger BE: Long-term prospective evaluation of offspring of diabetic mothers. Diabetes 1991; 40: 121– 125
    1. Gillman MW, Rifas-Shiman S, Berkey CS, Field AE, Colditz GA: Maternal gestational diabetes, birth weight, and adolescent obesity. Pediatrics 2003; 111: e221– e226
    1. Whitaker RC, Pepe MS, Seidel KD, Wright JA, Knopp RH: Gestational diabetes and the risk of offspring obesity. Pediatrics 1998; 101: e9.
    1. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ: Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007; 30: 2287– 2292
    1. Oken E, Gillman MW: Fetal origins of obesity. Obes Res 2003; 11: 496– 506
    1. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS: Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477– 2486
    1. Children, Youth, and Women's Health Services, Health Surveillance in Child and Family Health Division, Government of South Australia. CYWHS Nursing and Midwifery Clinical Standard. Measurement and assessment of the length/height of infants and children, and measurement and assessment of weight in infants and children 2007(Document cs2007-505). Available from the Clinical Governance, Education, and Research intranet Accessed 22 February 2009
    1. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240– 1243
    1. Vaska V, Volkmer R: Increasing prevalence of obesity in South Australian 4-year-olds: 1995–2002. J Paediatr Child Health 2004; 40: 353– 355
    1. Parker M, Rifas-Shiman SL, Belfort MB, Taveras EM, Oken E, Gillman MW: Pre- and peri-natal predictors of weight gain in early infancy. Pediatric Academic Societies' Annual Meeting, 2–5 May 2009, Baltimore Maryland
    1. HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes 2009; 58: 453– 459
    1. Wright CS, Rifas-Shiman SL, Rich-Edwards JW, Taveras EM, Gillman MW, Oken E: Intrauterine exposure to gestational diabetes, child adiposity, and blood pressure. Am J Hypertens 2009; 22: 215– 220
    1. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM, Jr, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB: Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361: 1339– 1348

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅