A study evaluating the risks of maternal glycemia related to the risk of obesity in childhood was just published in Diabetes Care by the American Diabetes Association. This study evaluated maternal glycemia using the universal gestational diabetes mellitus screening from two different multiethnic, geographically separate populations. There were 9,439 mother-child pairs that were included in the analysis for this study.
The key finding was that an increasing hyperglycemia was associated with an increased future risk of obesity in their children at age 5 to 7 years. The risk can be modified by treating the gestational diabetes.
Furthermore, the results suggest that there is a "metabolic imprinting" of the future child for obesity. This seems to occur when there is fasting hyperglycemia and greater than one abnormal reading on an OGTT occurs.
What do we know?
- Increased maternal hyperglycemia may be associated with future childhood obesity risk.
- Fasting hyperglycemia in particular may be associated with childhood obesity risk.
- This is the first study of a population besides the Pima Indians to evaluate childhood obesity with the total range of hyperglycemia in pregnancy.
- Metabolic imprinting in women and animal models with diabetes has been previously demonstrated.
- The altered metabolic mix of diabetes in pregnancy increases the offspring's risk of obesity and type 2 diabetes. This occurs more than what would be predicted by genetics alone.
- Historically, the strongest risk factor for obesity in Pima Indian children is maternal diabetes in utero, independent of maternal obesity and birth weight.
- Offspring of mothers with diabetes have up to a 10-fold increased risk of becoming obese during childhood and adolescence and developing impaired glucose tolerance as adolescents.
- Less is known on the degree to which obesity occurs in offspring of women with GDM (versus pre-existing type 1 or type 2 diabetes) in other ethnic groups.
- Macrosomia (see Kelsey Bonilla's recent blog entry) is a recognized short-term obesity complication of diabetes in pregnancy and an independent risk factor for future childhood obesity.
What can you do?
- This study suggests that treatment of gestational diabetes mellitus (GDM) may reduce childhood obesity rates and by metabolic mechanisms other than macrosomia.
- Macrosomia rates dramatically drop with treatment of gestational diabetes
- Recognize the risk factors for gestational diabetes
- If you develop gestational diabetes, BE PROACTIVE. Work closely with your Diabetes Team to develop a plan and course of treatment that will ensure you have a healthy infant.
- After your pregnancy, continue to work on reducing your risk factors for diabetes to minimize your risk for developing diabetes in the future