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J Clin Endocrinol Metab. 2015 Mar;100(3):986-93. doi: 10.1210/jc.2014-3239. Epub 2014 Dec 5.

Exposure to maternal gestational diabetes is associated with higher cardiovascular responses to stress in adolescent indians.

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Epidemiology Research Unit (G.V.K., S.R.V., S.C.K.), CSI Holdsworth Memorial Hospital, Mysore 570021, India; Centre for Cardiovascular Imaging (A.J.), University College London Institute of Cardiovascular Science, London W1T 7HA, United Kingdom; St John's Research Institute (G.V.K., K.S., A.V.K.), St John's National Academy of Health Sciences, Bangalore 560034, India; and Medical Research Council Lifecourse Epidemiology Unit (C.O., C.H.D.F.), University of Southampton, Southampton SO16 6YD, United Kingdom.



Altered endocrinal and autonomic nervous system responses to stress may link impaired intra-uterine growth with later cardiovascular disease.


To test the hypothesis that offspring of gestational diabetic mothers (OGDM) have high cortisol and cardiosympathetic responses during the Trier Social Stress Test for Children (TSST-C).


Adolescents from a birth cohort in India (n = 213; mean age, 13.5 y), including 26 OGDM, 22 offspring of diabetic fathers (ODF), and 165 offspring of nondiabetic parents (controls) completed 5 minutes each of public speaking and mental arithmetic tasks in front of two unfamiliar "evaluators" (TSST-C). Salivary cortisol concentrations were measured at baseline and at regular intervals after the TSST-C. Heart rate, blood pressure (BP), stroke volume, cardiac output, and total peripheral resistance were measured continuously at baseline, during the TSST-C, and for 10 minutes after the test using a finger cuff; the beat-to-beat values were averaged for these periods.


Cortisol and cardiosympathetic parameters increased from baseline during stress (P < .001). OGDM had greater systolic BP (mean difference, 5.6 mm Hg), cardiac output (0.5 L/min), and stroke volume (4.0 mL) increases and a lower total peripheral resistance rise (125 dyn · s/cm(5)) than controls during stress. ODF had greater systolic BP responses than controls (difference, 4.1 mm Hg); there was no difference in other cardiosympathetic parameters. Cortisol responses were similar in all three groups.


Maternal diabetes during pregnancy is associated with higher cardiosympathetic stress responses in the offspring, which may contribute to their higher cardiovascular disease risk. Further research may confirm stress-response programming as a predictor of cardiovascular risk in OGDM.

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