Mom's Gestational Diabetes Raises Childhood Risk of Obesity: Worldwide Study

Becky McCall

August 15, 2016

Maternal gestational diabetes (GDM) is associated with increased odds of offspring obesity at age 9 to 11 years, suggests a multinational study of more than 4700 children. However, note the authors, the association was only partially independent of current maternal body mass index (BMI).

The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was published online August 11 in Diabetologia and led by Pei Zhao, MD, from Tianjin Women’s and Children’s Health Center, China, in collaboration with researchers from Asia, Europe, Africa, and North and South America.

Children born to mothers who had gestational diabetes had significantly higher prevalence of general obesity (18.4% vs 12.0%, P = .006), central obesity (16.0% vs 9.6%, P = .003), and high body fat (12.1% vs 7.9%, P = .030) at age 9 to 11 years compared with children of mothers without gestational diabetes, according to the report. These children also had significantly higher mean birth weight (3415 g vs 3274 g, P = .001).

Previous studies have found that children born to women with gestational diabetes, which the authors note affects up to 28% of pregnancies, are at increased risk of obesity. But to date the majority of research has been in high-income countries, with limited data from countries with low to middle incomes. In light of this, the researchers acknowledged the need for studies of children from multiple regions of the world.

"Our study is the first to evaluate the association between maternal GDM and childhood obesity using such widespread, multinational data," write the authors. "Moreover, our results indicate that the positive associations between maternal GDM and the risk of childhood obesity were significant among children from low- to middle-income countries and between maternal GDM and an increased risk of central obesity among children from high-income countries."

The inclusion of a large multinational sample of children from low- to high-income countries was said to be a key strength of the study. In total, the study included 4740 children aged 9 to 11 years from Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States.

The cross-sectional study aimed to examine the association between maternal gestational diabetes, diagnosed according to the American Diabetes Association (ADA) or World Health Organization (WHO) criteria, and three indicators of childhood obesity (BMI, waist circumference, and body fat) in children aged 9 to 11 years.

Worldwide Association, but "Not Fully Independent"

The authors report that they found an association between maternal GDM and increased odds of general childhood obesity and central obesity in children aged 9 to 11 years old across the 12 countries. "However, these associations were not fully independent of maternal BMI."

Birth weights, obesity rates, and percentage body fat varied widely around the world. Overall prevalence of reported maternal gestational diabetes was 4.3% but ranged from 1.9% in the United Kingdom and China to 8.8% in Portugal. Mothers with gestational diabetes had significantly older age at delivery than mothers without gestational diabetes (29.9 years vs 28.3 years, P < .001).

Of note, adjusted odds ratios among children of mothers with GDM compared with children of mothers without gestational diabetes were 1.53 (P = .034) for general obesity, 1.73 (P = .01) for central obesity, and 1.42 (P = .14) for high body fat. Adjustments were made for maternal age at delivery, maternal education, infant feeding mode, gestational age, number of younger siblings, child unhealthy-diet pattern scores, moderate to vigorous physical activity, sleeping time, sedentary time, age, sex, and birth weight.

Of note, according to the group, these associations were no longer significant after further adjustment for current maternal BMI (about 10 years' postpartum).

Mechanisms Behind the Findings?

Areas for further research, the authors write, include exploration of the effects of maternal gestational diabetes on the risks of childhood obesity and central obesity. Also, the mechanisms responsible for increased obesity risk in these children need further clarification.

Of note, according to the authors, "exposure to maternal diabetes is associated with excess fetal growth in utero, possibly mainly due to an increase in fetal fat mass and alterations in fetal hormone levels. In addition, exposure to maternal diabetes results in elevated hyperglycemia, hyperinsulinemia, and elevated leptin synthesis in offspring."

Some research also suggest that gestational diabetes might cause an epigenetic alteration in the fetal genome, the group notes, influencing the expression of genes that direct the accumulation of body fat or related metabolism.

Dr Zhao has no relevant financial relationships. Disclosures for the coauthors are listed in the article.

Diabetologia. Published August 11, 2016. Abstract

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