A new article published in Diabetes Care (October 2017) by Danish Diabetes Academy Post Doc Louise G. Grunnet discusses the long term consequences for the offspring of mothers with gestational diabetes.
Offspring of pregnancies affected by gestational diabetes mellitus (GDM) are at increased risk of developing obesity, metabolic disorders and type 2 diabetes. However, the extent to which these dysmetabolic traits may be due to offspring and/or maternal adiposity is unknown.
LARGE COHORT OF ADOLESCENCE OFFSPRING OF WOMEN WITH AND WITHOUT PREVIOUS GDM
In the present study, clinical and metabolic characteristics are reported including body composition and puberty status in a large cohort (n=1158) of 9-16 years old offspring of women with and without previous GDM recruited from the Danish National Birth Cohort. Additionally, they examine the association of GDM with offspring metabolic disease and puberty development while accounting for offspring and maternal degree of adiposity.
In these adolescence offspring they measured anthropometric measurements, puberty status, blood pressure, fasting glucose, insulin, C-peptide and lipid levels and in a subset conducted a DEXA scan in order to examine body composition.
GDM OFFSPRING MORE INSULIN RESISTANT THAN CONTROL OFFSPRING
When comparing the GDM offspring with the control offspring, results showed that after adjusting for age and sex, adolescent GDM offspring displayed:
- Higher weight, BMI, waist-to-hip ratio and lower height
- Higher systolic blood pressure
- Higher fasting glucose, insulin and C-peptide levels
- Higher fat percentages, less muscle mass and more fat located at the abdomen.
- Earlier onset of puberty among female offspring
Even after adjustment for the offspring’s own BMI and maternal pre-pregnancy BMI, the GDM offspring were still more insulin resistant than control offspring. Furthermore, the GDM offspring also have higher BMI and higher waist circumference and waist-to-hip ratio after adjustment for maternal-pre-pregnancy BMI. Interestingly, the difference in metabolic and body composition outcomes between GDM and control offspring appears to be stronger among offspring whose mothers were of normal weight in pregnancy (BMI ˃18.5 and <25 kg/m2).
MOUNTING EVIDENCE OF ADIPOSITY, INSULIN RESISTANCE AND T2D ROOTED IN PREGNANCY WITH HYPERGLYCEMIA IN THE MOTHER
The study adds to the mounting evidence of adiposity, insulin resistance and type 2 diabetes being rooted in pregnancy with hyperglycemia in the mother being one among possibly many adverse etiological factors. To prevent diabetes in future generations, a focus on the earliest environment starting from even before pregnancy is needed.
AUTHORS AND AFFILIATIONS
Louise G. Grunnet1,4, Susanne Hansen2, Line Hjort1,3,4, Camilla M. Madsen1, Freja B. Kampmann, 1,4,5, Anne Cathrine B. Thuesen1, Charlotta Granstrøm2, Marin Strøm2,6, Ekaterina Maslova, 2,4,7, Ruth Frikke-Schmidt8 , Peter Damm 9, Jorge E. Chavarro 10, Frank B. Hu 11, Sjurdur F. Olsen2, Allan Vaag1,12
1Department of Endocrinology - Diabetes and Metabolism, Rigshospitalet, Copenhagen Denmark
2Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
3Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
4Danish Diabetes Academy, Odense, Denmark
5Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Søborg, Denmark
6 Faculty of Natural and Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
7Department of Primary Care and Public Health, Imperial College, London, UK
8 Department of Clinical Biochemistry, Rigshospitalet, Copenhagen Denmark
9Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
10Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health &Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School
11 Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
12 Astrazeneca, Early Clinical Development, Göteborg, Sweden
Source: Diabetes Care