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Maternal Diabetes and Risk for Asthma in the Offspring 

Apr 11, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Antonio Bess, Pharm D Candidate, Florida Agricultural & Mechanical University School of Pharmacy

Improved understanding of the causes of asthma will allow for better prevention, monitoring, and treatment; study explores the link between diabetes and asthma. 

Gestational diabetes is a significant risk factor for perinatal complications and can predispose the offspring to chronic health complications. Many women with gestational diabetes often normalize after giving birth, but their risk for developing type 2 diabetes mellitus later in life is substantially increased. The relationship between childhood asthma and maternal diabetes history lacks evidence. The origins of asthma are thought to be environmental and gene-related. A previous study done in Canada suggested that maternal diabetes could expose the child to asthma if environmental tobacco smoke and maternal asthma were present. Asthma is a chronic lung disease caused by continued airway inflammation that is marked by episodes or attacks of inflammation. Known risk factors for asthma include allergies, frequent respiratory infection, low birth weight, and second-hand smoke exposure. The present study was developed to characterize the associations between preexisting maternal diabetes and GDM and the risk of childhood asthma in offspring. 

This retrospective and longitudinal birth cohort study used data from a large population-based clinical cohort. Children included were singletons born at 28-44 weeks of gestation between January 1, 2007, and December 31, 2011, in Kaiser Permanente Southern California (KPSC) hospitals. To be eligible for this study, children had to be enrolled as a KPSC health plan member by age five and had a follow-up from age 5. Children were followed from age 5 through electronic medical records until the first date of the following: (1) year of clinical diagnosis of asthma, (2) last date of continuous KPSC health plan membership, (3) death from any cause, or (4) December 31, 2017. Children could be easily linked to their mothers through a unique patient identifier. Children with missing or invalid data on maternal race/ethnicity, sex, birth weight, and maternal age outside of 15-55 years were excluded. A total of 97,554 children born to 85,422 women were eligible and included in the final data analysis. 

Mothers with pre-existing type 2 diabetes mellitus or gestational diabetes were the primary exposure. The diagnosis of maternal GDM was based on laboratory glucose values from 1-hour, 50-g glucose challenge test of 200 mg/dL or higher or 3-hour 100-g or 2-hour 75-g oral glucose tolerance tests during pregnancy with at least two abnormal plasma glucose values. The primary outcomes were the presence or absence of asthma and age at initial diagnosis or last follow-up. A confirmation of asthma occurred if it met the following conditions: (1) one or more inpatient or emergency encounter owing to asthma, (2) one or more outpatient meeting due to asthma and at least one asthma-specific medication dispensed within one year of the diagnosis, or (3) three or more outpatient encounters owing to asthma if no asthma specific medications were dispensed. 

The results of the study found associations between maternal diabetes and childhood asthma. There were 3,119 children (3.2%) who were exposed to preexisting type 2 diabetes and 9,836 (10.1%) to gestational diabetes mellitus. Among mothers with gestational diabetes mellitus, 3,380 (34.4%) were dispensed antidiabetic medication during pregnancy. Frequencies of children with asthma were 17.7% and 15.0% for the GDM with and without medication use groups, respectively (P < .001). The women who had gestational diabetes who did not use medications had no higher risk than the unexposed group (P = .75). 

During a median of 7.6 years after birth, 15,125 children (15.5%) were diagnosed with asthma after age five. Maternal diabetes interacted with maternal asthma history to affect a child’s asthma risk (P = .05). Frequencies of children with asthma after exposure to T2D, GDM, or no diabetes were 19.5%, 15.9%, and 15.3%, respectively (P <.001 for differences among groups). Gestational age at gestational diabetes diagnosis was not associated with childhood asthma (P = .27). 

Compared with no diabetes during pregnancy, preexisting maternal T2D was associated with a statistically significant effect on a child’s asthma risk (approximately 20% increased risk) among mothers without a history of asthma. The risk increased to about 50% among mothers with a history of asthma. GDM requiring antidiabetic medication treatment during pregnancy was associated with a small effect on a child’s asthma risk (approximately 10% increased risk) and the chance was similar for mothers with or without a history of asthma. This study provided insight into the relationship between diabetic pregnancy and the risk of asthma in offspring. Being that this study was from a large cohort in America, its result can be used for future citations and implemented into healthcare practice. 

  

Practice Pearls: 

  • Preexisting type 2 diabetes was associated with a significantly increased risk for asthma in the offspring. 
  • Uncontrolled gestational diabetes has a higher risk of asthma for the offspring. 
  • Mothers with both asthma and diabetes put the offspring at an increased risk for asthma. 

Martinez, Mayra P., et al. “Maternal Gestational Diabetes and Type 2 Diabetes During Pregnancy and Risk of Childhood Asthma in Offspring.” Journal of Pediatrics, Mosby Inc., 2020,doi:10.1016/j.jpeds.2019.12.053. 

Azad, Meghan B., et al. “Association of Maternal Diabetes and Child Asthma.” Pediatric Pulmonology, vol. 48, no. 6, John Wiley & Sons, Ltd, June 2013, pp. 545–52, doi:10.1002/ppul.22668. 

Damm, Peter, et al. “Gestational Diabetes Mellitus and Long-Term Consequences for Mother and Offspring: A View from Denmark.” Diabetologia, vol. 59, no. 7, Springer Verlag, 1 July 2016, pp. 1396–99, doi:10.1007/s00125-016-3985-5. 

Antonio Bess, Florida Agricultural and Mechanical University College of Pharmacy 

 

 

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