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J Clin Endocrinol Metab. 2019 Mar 5. pii: jc.2018-02743. doi: 10.1210/jc.2018-02743. [Epub ahead of print]

Gestational diabetes, but not pre-pregnancy overweight predicts cardio-metabolic markers in offspring twenty years later.

Author information

1
National Institute for Health and Welfare, Helsinki and Oulu, Finland.
2
PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.
3
Department of Nursing Science, University of Turku, Turku, Finland.
4
Institute of Health Sciences, University of Oulu, Oulu, Finland.
5
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
6
Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
7
Department of Psychology, University of Warwick, Warwick, United Kingdom.
8
NordLab Oulu, Oulu University Hospital, Oulu, Finland.
9
Department of Clinical Chemistry, University of Oulu, Oulu, Finland.
10
Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, London, UK.
11
Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.
12
Biocenter Oulu, University of Oulu, Oulu, Finland.
13
Unit of Primary Care, Oulu University Hospital, Oulu, Finland.
14
Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, United Kingdom.
15
Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
16
Folkhälsan Research Center, Helsinki, Finland.
17
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

CONTEXT:

Maternal gestational diabetes (GDM) and pre-pregnancy overweight/obesity (body mass index, BMI ≥25kg/m2) may adversely affect offspring cardio-metabolic health.

OBJECTIVE:

To assess associations of maternal GDM and pre-pregnancy overweight/obesity with adult offspring cardio-metabolic risk factors.

DESIGN:

Longitudinal cohort study (ESTER and AYLS).

SETTING:

Province of Uusimaa and Northern Finland.

PARTICIPANTS:

At mean age 24.1 years (SD 1.3), we classified offspring to offspring of mothers with 1) GDM regardless of pre-pregnancy BMI (OGDM; n=193), 2) normoglycemic mothers with pre-pregnancy overweight/obesity (ONO, n=157) and 3) normoglycemic mothers with pre-pregnancy BMI<25kg/m2 (controls, n=556).

MAIN OUTCOME MEASURES:

We assessed cardio-metabolic biomarkers from blood and measured resting blood pressure and heart rate.

RESULTS:

Compared with controls, OGDM and ONO had higher fasting glucose [1.6% (95% confidence interval 0.1, 3.1)]; [2.3% (0.5, 4.3), respectively]; and insulin [12.7% (4.4, 21.9)]; [8.7% (0.2, 17.8)]. These differences attenuated to non-significance when adjusted for confounders and/or current offspring characteristics including BMI or body fat percentage. OGDM showed lower sex hormone binding globulin [SHBG; men: -12.4% (-20.2, -3.9), women: -33.2% (-46.3, -16.8)], high-density lipoprotein [-6.6% (-10.9, -2.2)] and apolipoprotein A1 [-4.5% (-7.5, -1.4), these differences survived the aforementioned adjustments. Heart rate and other biomarkers were similar between groups.

CONCLUSIONS:

Adult offspring of mothers with GDM have increased markers of insulin resistance and a more atherogenic lipid profile; these are only partly explained by confounders or current offspring adiposity. Maternal pre-pregnancy overweight/obesity is associated with impaired offspring glucose regulation, which is explained by confounders and/or current adiposity.

PMID:
30835282
DOI:
10.1210/jc.2018-02743

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