Type of Diabetes in Pregnancy Impacts Risk for Child

Marlene Busko

June 12, 2018

A new study has shown that important differences exist in the diabetes risk of offspring based on the type of diabetes exposure in utero.

The likelihood of developing type 2 diabetes before age 30 was greatest in the children of First Nations (indigenous) women with type 2 diabetes, shows research conducted in the province of Manitoba, Canada.

Having a First Nations mother with gestational diabetes conferred a smaller but still greatly increased risk of early onset type 2 diabetes compared with having a First Nations mother without diabetes.

Meanwhile children of non-First Nations women exposed to diabetes in utero had smaller increased risks of early onset type 2 diabetes, but again, risks were higher if their moms had type 2 diabetes.

Non-First Nations offspring were more likely to develop early onset type 2 diabetes in their teens or 20s — as opposed to as young as age 4 in the indigenous children — in this study by Brandy A. Wicklow, MD, and colleagues from the Department of Pediatrics and Child Health, University of Manitoba, Winnipeg.

"These findings have implications for future research and clinical practice guidelines, including early pregnancy screening and follow-up of the offspring," write the authors in the article published online June 11 in JAMA Pediatrics. 

Implications for Many Types of Clinicians

The results are important for many types of clinicians, including obstetricians, pediatricians, and clinicians who treat adolescents, Wicklow told Medscape Medical News.

Clinicians who treat adolescents need to stress the importance of glycemic control in female teens with type 2 diabetes (before they ever become pregnant) and inform them of the benefits of breastfeeding to lower the risk of diabetes in their children.

In addition, "we don't routinely test [pregnant women] for type 2 diabetes when they first walk through the door, and so by default everybody is just called 'diabetes in pregnancy,' whether it is gestational diabetes or type 2 diabetes," she explained.

"I think that's wrong," she continued. Clinicians should test women "well before 20 weeks" of pregnancy to detect type 2 diabetes.

Obstetricians meanwhile should reinforce the messages about glycemic control and breastfeeding.

And pediatricians should start screening for diabetes in First Nations children at an early age. If their mothers had type 2 diabetes during pregnancy, screening should start around age 8, 9, or 10, regardless of symptoms, and continue annually.

First Nations Kids at Much Higher Risk of Diabetes

The prevalence of diabetes in pregnant women has increased over the past 20 years, partly driven by increasing obesity rates, Whitlow and colleagues note.

Moreover, diabetes affects indigenous people more than others worldwide.

Manitoba has a fairly large indigenous population, and a 20-fold higher rate of childhood-onset type 2 diabetes, compared with other Canadian provinces.

About 14% of the Manitoba population is indigenous, of which 60% are First Nations and the rest are Métis (mixed European and indigenous) or Inuit (who live in the north).

Until now it was not clear if in utero exposure to gestational diabetes or type 2 diabetes was associated with the same risk of early onset type 2 diabetes in offspring.

Using a provincial database, Whitlow and colleagues identified 467,850 mother-infant dyads of children born in Manitoba between 1984 and 2008 who were followed for a mean 17.7 years (and up to 30 years).

The offspring included 89,231 First Nations children — 1796 of whom were exposed to type 2 diabetes and 1527 to gestational diabetes in the womb — and 378,619 non-First Nations offspring — 1992 of whom were exposed to type 2 diabetes and 2504 to gestational diabetes in utero.

First Nations mothers and infants were more likely to live in disadvantaged and rural neighborhoods.

Among pregnant First Nations women, 3.8% had gestational diabetes and 3.5% had type 2 diabetes, whereas among non-First Nations pregnant women, only 1.6% had gestational diabetes and 0.8% had type 2 diabetes.

Offspring from First Nations mothers exposed to diabetes in utero were much more likely to develop early onset type 2 diabetes. Moreover, type 2 diabetes developed at a much earlier age in First Nations children compared with other children. 

Incidence of Early Onset T2DM in Offspring 

Population Mother Had T2DM
in Pregnancy
Mother Had
Gestational Diabetes
Mother Did Not Have
Diabetes in Pregnancy
First Nations, incidence per 1000 person-years 5.63 1.67 0.83
Non-First Nations, incidence per 1000 person-years 1.17 0.29 0.13
All, incidence per 1000 person-years 3.19 0.80 0.27
T2DM = type 2 diabetes mellitus
 

Address Historical Wrongs, Screen Early for Type 2 Diabetes

"The intergenerational nature of type 2 diabetes among [First Nations] people is unquestionably related to historical trauma and loss of language, culture, and land associated with colonization," Whitlow and colleagues write.

"Addressing structural inequality and poverty at a policy level may contribute the most to reducing rates of diabetes in [First Nations] people," they suggest.

In addition, for all pregnant mothers the "American Diabetes Association guidelines recommend preconception counseling, early screening, and aggressive glycemic management to mitigate risks to the mother and newborn."

"Our findings also inform practitioners of the need for routine early screening and diagnosis of type 2 diabetes in mothers and their offspring," the researchers conclude.

The study was funded by the Children's Hospital Research Institute of Manitoba. The authors have reported no relevant financial disclosures.

JAMA Pediatrics. Published online June 11, 2018. Full Text

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