Gestational diabetes and childhood obesity: what is the link?

aDivision of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention bUS Public Health Service Commission Corps, Atlanta, Georgia, USA.
Current opinion in obstetrics & gynecology (Impact Factor: 2.49). 01/2012; 24:376-81. DOI: 10.1097/GCO.0b013e328359f0f4

ABSTRACT PURPOSE OF REVIEW: To review recently published studies examining the role of prepregnancy obesity in the relationship between gestational diabetes mellitus and childhood obesity. RECENT FINDINGS: Seven epidemiologic studies published from January 2011 to February 2012 differentiate between preexisting diabetes mellitus and gestational diabetes mellitus, and six of them examine the role of maternal obesity. In studies that account for maternal obesity as a covariate, the association between gestational diabetes mellitus and childhood obesity is attenuated significantly after adjustment for prepregnancy BMI. In the one study that does not adjust for maternal obesity, maternal glucose level during pregnancy is associated with greater offspring adiposity, independent of the child's diet and lifestyle. SUMMARY: This review shows a positive association between maternal gestational diabetes mellitus and offspring overweight and obesity that is attenuated significantly after adjustment for prepregnancy BMI. The relationship between maternal gestational diabetes mellitus and offspring overweight and obesity could reflect fetal programming, shared genes and/or shared environments, such as postnatal diet and physical activity. Maternal gestational hyperglycemia and subsequent fetal hyperinsulinemia may predispose offspring to increased adiposity, impaired glucose tolerance, hyperinsulinemia, and insulin resistance. Because maternal obesity is a more prevalent condition than gestational diabetes mellitus and strongly associated with offspring obesity, effective interventions addressing prepregnancy obesity need to be further explored as they may have a greater public health impact on childhood overweight and obesity than those targeting women with gestational diabetes mellitus.

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    ABSTRACT: The early life course is assumed to be a critical phase for childhood obesity; however the significance of single factors and their interplay is not well studied in childhood populations. The investigation of pre-, peri- and postpartum risk factors on the risk of obesity at age 2 to 9. A case-control study with 1,024 1∶1-matched case-control pairs was nested in the baseline survey (09/2007-05/2008) of the IDEFICS study, a population-based intervention study on childhood obesity carried out in 8 European countries in pre- and primary school settings. Conditional logistic regression was used for identification of risk factors. For many of the investigated risk factors, we found a raw effect in our study. In multivariate models, we could establish an effect for gestational weight gain (adjusted OR = 1.02; 95%CI 1.00-1.04), smoking during pregnancy (adjusted OR = 1.48; 95%CI 1.08-2.01), Caesarian section (adjusted OR = 1.38; 95%CI 1.10-1.74), and breastfeeding 4 to 11 months (adjusted OR = 0.77; 95%CI 0.62-0.96). Birth weight was related to lean mass rather than to fat mass, the effect of smoking was found only in boys, but not in girls. After additional adjustment for parental BMI and parental educational status, only gestational weight gain remained statistically significant. Both, maternal as well as paternal BMI were the strongest risk factors in our study, and they confounded several of the investigated associations. Key risk factors of childhood obesity in our study are parental BMI and gestational weight gain; consequently prevention approaches should target not only children but also adults. The monitoring of gestational weight seems to be of particular importance for early prevention of childhood obesity.
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    ABSTRACT: Aim Investigate if the maternal use of flaxseed oil prevents pancreatic alterations in the offspring of diabetic mothers. Methods Diabetes was induced in female wistar rats (n = 12) by a high-fat diet and low-dose of streptozotocin. After the confirmation of the diabetes (glucose > 300 mg/dL), rats were mated and once pregnancy was confirmed, they were allocated into three groups (n = 6): High-Fat Group (HFG); Flaxseed Oil Group (FOG); and, Control Group (CG) (nondiabetic rats). At weaning, male offspring (n = 12/group) received a standard chow diet. The animals were euthanized in two phases: at 100 and at 180 days, (n = 6/group). The pancreas was collected for histomorphometric and immunohistochemistry analysis. Results HFG showed hypertrophy of pancreatic islets at 100 and at 180 days (p < 0.0001), while the FOG offspring had islets with smaller diameters compared to HFG at both phases of sacrifice (p < 0.0001). HFG had a lower percentage of small islets when compared to CG and FOG, which had a higher percentage when compared to HFG (p = 0.0053) at 100 days. At 180 days HFG showed higher percentage of larger islets (p = 0.00137) and lower percentage of smaller islets (p = 0.00112), when compared to FOG. HFG showed lower islet insulin imunnodensity at 100 days (p < 0.0001) and 180 days (p < 0.0001), whereas FOG was similar to CG (p < 0.0001) at 100 days and higher at 180 days (p < 0.0001). Conclusions Flaxseed oil reduced the damage caused by maternal hyperglycemia, promoting normal pancreas histomorphometry and β cell mass.
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