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Gestational Diabetes Ups Type 1 Diabetes Risk in Kids

May 4, 2019
 

Author: Steve Freed, R.PH., CDE


According to results of a large observational cohort study of gestational diabetes and type 1 diabetes risk, children and youth whose mothers had gestational diabetes were almost twice as likely as their peers to develop diabetes by age 22.

Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Early detection of diabetes is important in children and youth, as many—about 25 percent—only receive a diagnosis when seeking care for diabetic ketoacidosis, a potentially life-threatening complication of diabetes that can occur when the body starts running out of insulin.

“Although type 1 and type 2 diabetes in parents are well-established risk factors for their offspring to become diabetic, we show in this study that gestational diabetes may also be a risk indicator for type 1 diabetes in the mother’s children,” says senior study author Kaberi Dasgupta, an associate professor of medicine at McGill University and director and senior scientist of the Centre for Outcomes Research and Evaluation at the Research Institute of the McGill University Health Centre. “We found that a child or teen whose mother had gestational diabetes was nearly twice as likely to develop type 1 diabetes before the age of 22.”

The study of 73,180 mothers compared data on randomly selected single births from mothers with gestational diabetes to births from mothers without gestational diabetes. The incidence — the number of new cases of diabetes per 10,000 person-years — was 4.5 in children born to mothers with gestational diabetes and 2.4 in mothers without. A child or teen whose mother had gestational diabetes was nearly twice as likely to develop diabetes before the age of 22 years. The association was found in children from birth to age 22 years, from birth to 12 years, and from 12 to 22 years.

A previous Swedish study showed that children and youth whose mothers had either gestational diabetes or type 2 diabetes had a heightened risk of diabetes onset by age 22.

Now the current study is the first to show that gestational diabetes alone is associated with type 1 diabetes in children and youth. This risk was higher in adolescents (a 2.5-fold increased risk) than in younger children (a 40% increased risk).

Among children born to mothers with gestational diabetes, 139 developed diabetes before age 12, and 95 developed diabetes between ages 12 to 22.  Of those born to mothers without gestational diabetes, 92 developed diabetes before age 12, and 33 developed diabetes between ages 12 to 22. That is, the incidence of pediatric diabetes was 4.52/10,000 patient-years among offspring of mothers with gestational diabetes versus 2.4/10,000 patient-years among offspring of mothers who did not have gestational diabetes.

Maternal gestational diabetes conferred a 1.8-fold higher risk of type 1 diabetes in the children, after adjusting for sex, gestational age group, birth weight group, ethnicity, material deprivation, previous pregnancy, and maternal autoimmune disease.  

Further analysis revealed the risk was higher in teens and young adults.  The current study now links gestational diabetes with type 1 diabetes in offspring. However, the mechanism remains to be elucidated.

This study hopefully will stimulate “clinicians, parents, and even children and youth to consider the possibility of diabetes if offspring of a mother with gestational diabetes mellitus develop signs and symptoms such as polyuria, polydipsia, weight loss, or fatigue,” the researchers note.

 

Practice Pearls

  • Only a small number of children will develop diabetes before the age of 22, even if their mothers had gestational diabetes.
  • The number of new cases of diabetes per 10,000 person-years was 4.5 in children born to mothers with gestational diabetes and 2.4 in mothers without.
  • Maternal gestational diabetes conferred a 1.8-fold higher risk of type 1 diabetes in the children.

Andrea L. Blotsky, Elham Rahme, Mourad Dahhou, Meranda Nakhla, Kaberi Dasgupta. Gestational diabetes associated with incident diabetes in childhood and youth: a retrospective cohort study. Canadian Medical Association Journal, 2019; 191 (15): E410 DOI: 10.1503/cmaj.181001