Gestational Diabetes in Mom Predicts Diabetes Risk in Dad: Cohort Study

Veronica Hackethal, MD

August 21, 2015

A large study covering over 20 years of data from Quebec has found that fathers with partners who have had gestational diabetes (GDM) may be at increased risk for developing diabetes themselves. The study is to be published in the September issue of Diabetes Care.

"In this study we demonstrated that men whose partners had a history of GDM in pregnancy had a relative risk increase of 33% of developing diabetes in the 13 years that followed," commented first author Kaberi Dasgupta, MD, MSc, an associate professor of Medicine at McGill University in Montreal, Quebec.

"Practicing clinicians should frame this as an issue for the family, so it's not just an issue for Mom to make some changes so that the baby is healthy. Of course that's important, but it's something that everyone needs to tackle together," she said, "I think it gives us as practicing clinicians a lever to say, 'By working together now, you're going to improve your personal health and the health of your child in the future.' "

Women who develop GDM during pregnancy may have up to seven times increased risk of developing type 2 diabetes in later life, according to background information in the article. Past studies have shown that partners often share lifestyle habits — when one partner gains weight or becomes more physically active, the other one often does, too, according to Dr Dasgupta.

In this study, Dr Dasgupta and colleagues went a step further and hypothesized that men whose partners have GDM might also have increased risk for type 2 diabetes.

The study used information from administrative, birth, and death registries from Quebec province, which provides universal health coverage to its residents. The researchers used ICD-9 and -10 diagnostic codes to randomly select women diagnosed with GDM who had singleton births between April 1990 and December 2007. Then they matched these women by age, year of delivery, and health region to other women who did not have GDM. Finally, they looked at the development of diabetes in fathers who did not have diabetes at the time of their partners' pregnancies.

The study did not measure actual health behaviors, Dr Dasgupta pointed out, because it was based on administrative data that did not include this information.

The analysis included 70,890 fathers, 50% of whom were partners of women with GDM. Over 90% of these men lived with their partners, and over 90% shared the same ethnocultural background as their partner.

Compared with fathers with partners without GDM, fathers with partners with GDM tended to live in socioeconomically deprived neighborhoods (43.3% vs 37.3% for the two most deprived quintiles), and were of non-European background (23.2% vs 18.1%).

Over a mean follow-up of 13 years, fathers with partners with GDM had 33% higher incidence of developing diabetes compared with fathers with partners without GDM (1838 [5.2%] vs 1397 [3.9%], respectively; hazard ratio [HR], 1.33; 95% CI 1.24–1.43).

After adjustment for age, comorbidities, cohabitation, ethnocultural background, and deprivation level, the risk of developing diabetes was 18% higher in fathers with partners with GDM compared with fathers with partners without GDM (HR, 1.18; 95% CI 1.09–1.27).

Shared living and socioeconomic environments may partly explain the increased risk for diabetes in male partners of women with GDM, the authors wrote.

"The key is that we acknowledge that genes and biological family history are big drivers for diabetes risk, but we can't underplay the importance of our behaviors and our environments," Dr Dasgupta emphasized. "It's hard for individuals to make behavioral changes on their own. It's really about communities and groups and, in this case, about families changing things together."

"The findings of this study are really interesting because they highlight the fact that diabetes is not just about genetics, it's also about the environmental impact. Partners will be living in similar neighborhoods, eating similar diets, and will probably have similar behaviors. If somebody is prone to have diabetes, then other people living in that household are also prone to have diabetes," agreed Baiju Shah, MD, PhD, associate professor in the department of medicine at the University of Toronto, Ontario.

Dr Shah, who was not involved in the research, is the coauthor of a study on a related topic, which suggested that pregnant women who carry sons may be more likely to develop GDM than women who carry daughters (J Clin Endocrinol Metab. 2015;100:2574-2580).

Thinking about diabetes from a community and neighborhood perspective, rather than from a clinical perspective based mostly on the individual, is an "evolving frame shift," according to Dr Shah.

"The key is to think about diabetes prevention. We counsel women with GDM that [lifestyle change] is really important for them in the postpartum period. I think we should remember that it's also important for the fathers," Dr Shah emphasized, "Making lifestyle changes as a family and modeling that behavior for the children is really important. It helps set a healthy lifestyle in the whole household."

The authors and Dr Shah report no relevant financial relationships.

Diabetes Care. Published online June 26, 2015. Article

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