Treating gestational diabetes mellitus (GDM) during pregnancy may reduce the child’s risk of becoming obese, according to the results of a new study.
"Diabetes in pregnancy is associated with an increased rate of offspring childhood obesity, impaired glucose tolerance, and type 2 diabetes," write Teresa A. Hillier, MD, MS, from the Center for Health Research, Kaiser Permanente Northwest in Portland, Oregon, and colleagues. "We sought to determine whether increasing hyperglycemia in pregnancy, ranging from normal to GDM, is related to childhood obesity in offspring during the typical period of adiposity rebound in a diverse population."
Between 1995 and 2000, universal screening of GDM was performed in 2 regions (Northwest and Hawaii) of a large, diverse health maintenance organization (HMO), with a 50-g glucose challenge test. Criteria from the National Diabetes Data Group were used to diagnose GDM with a 3-hour, 100-g oral glucose tolerance test (OGTT).
At 5 to 7 years later, weight in the offspring (n = 9439) was measured to calculate sex-specific weight-for-age percentiles with use of US norms (1963 – 1994 standard). These were classified based on maternal positive results of glucose challenge test (1 hour ≥ 7.8 mmol/L) and OGTT (1 or ≥ 2 of the 4 time points abnormal: fasting, 1, 2, or 3 hours by Carpenter and Coustan and National Data Diabetes Group criteria).
Across the range of increasing maternal glucose screen values was a positive trend for increasing childhood obesity at 5 to 7 years of age (P < .0001; 85th and 95th percentiles). This trend remained after adjusting for potential confounders, such as maternal weight gain, maternal age, parity, ethnicity, and birth weight.
The offspring of mothers with GDM by National Diabetes Data Group criteria that was treated had a lower risk for childhood obesity than did those with lesser degrees of hyperglycemia that was untreated. The pattern was similar for whites vs nonwhites, as well as in children of normal birth weight (≤ 4000 g).
"Our results in a multiethnic US population suggest that increasing hyperglycemia in pregnancy is associated with an increased risk of childhood obesity," the study authors write. "More research is needed to determine whether treatment of GDM may be a modifiable risk factor for childhood obesity."
"These results suggest that metabolic imprinting of the child for future obesity occurs in women with GDM (not only in those with preexisting diabetes), and, thus, GDM screening might have long-term benefits to offspring," the study authors conclude. "They also suggest that GDM treatment may decrease the risk of childhood obesity and provide an additional reason for screening for GDM in pregnancy."
Diabetes Care. 2007;30:2287-2292.
A successful start to insulin therapy is about doing the right thing at the right time. A reusable, digital insulin pen for use with Humalog(r) (insulin lispro) can offer patients greater flexibility. Humalog(r) and Humalog(r) Mixture insulins are available in convenient insulin pens. The new HumaPen(r) Luxura(tm) HD — offered with half unit increments from 1 to 30 — and HumaPen(r) MEMOIR both offer greater flexibility. Find progressive dosing guidelines that can help simplify starting insulin in patients new to insulin or those adding Humalog(r) to basal insulin here