Glucose tolerance of offspring of mother with gestational diabetes mellitus in a low-risk population

Division of Endocrinology and Metabolism, University of Ottawa, Ontario, Canada.
Diabetic Medicine (Impact Factor: 3.12). 06/2006; 23(5):565-70. DOI: 10.1111/j.1464-5491.2006.01840.x
Source: PubMed

ABSTRACT To describe the prevalence of impaired glucose tolerance and obesity in offspring of mothers whose pregnancies were complicated by gestational diabetes mellitus (GDM) in a low-risk population and to investigate the effect on these outcomes of minimal intervention compared with tight control for management of GDM.
Eighty-nine children (mean age 9.1 years, 93% Caucasian) were recruited through a follow-up study of women previously involved in a randomized controlled trial of minimal intervention (control group) vs. tight glycaemic control (treatment group) for GDM. Fasting blood glucose (FBG) and 2-h glucose tolerance tests (2hGTT) were performed on offspring and body mass index (BMI) calculated. Glucose tolerance and BMI of treatment groups were compared using non-inferiority tests (non-inferiority margin -15%).
Of those offspring, 6.9% (5/72) had abnormal glucose metabolism [four children had impaired glucose tolerance (IGT) and one had Type 2 diabetes mellitus (DM) (all Caucasian)]. Of the four children with IGT, three were male, three had normal BMI, and three had a family history of Type 2 diabetes. Of the 71 offspring who underwent 2hGTT, 25/25 (100%) of the control offspring and 46/46 (100%) of the treatment offspring had normal FBG (FBG < 5.7 mmol/l). Twenty-five of 25 (100%) of control and 42/46 (91.3%) of the treatment offspring had normal glucose tolerance (2hGTT < 7.8 mmol/l) (% difference 8.7, 95% CI -5.6, 20.3). BMI < 85th percentile was found in 25/33 (75.8%) of the treatment group and 44/52 (84.6%) of the control group (difference in percentage -8.9, 95% CI -27.2, 7.8).
School-age children of mothers with GDM are at risk of IGT and overweight, even if from a low-risk ethnic population. FBG was not adequate for screening this population. Minimal intervention for glycaemic control in GDM pregnancies appears to be as effective as tight control for preventing IGT in childhood but not for preventing obesity.

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    • "Results of the long-term follow-up of the offspring are not yet available. However, in 71 children assessed between 7–11 years of age, Malcolm and colleagues found that interventions in women with gestational diabetes aiming for either minimal or tight glycemic control during pregnancy [115] were equally effective for the prevention of impaired glucose tolerance [116]. However, this conclusion needs to be interpreted with caution because no control group was included and this study was limited by its relatively small sample size. "
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    ABSTRACT: Prepregnancy overweight or obesity and excessive gestational weight gain have been associated with increased risk of maternal and neonatal complications. Moreover, offspring from obese women are more likely to develop obesity, diabetes mellitus, and cardiovascular diseases in their lifetime. Gestational diabetes mellitus (GDM) is one of the most common complications associated with obesity and appears to have a direct impact on the future metabolic health of the child. Fetal programming of metabolic function induced by obesity and GDM may have intergenerational effect and thus perpetuate the epidemic of cardiometabolic conditions. The present paper thus aims at discussing the impact of maternal obesity and GDM on the developmental programming of obesity and metabolic disorders in the offspring. The main interventions designed to reduce maternal obesity and GDM and their ability to break the vicious circle that perpetuates the transmission of obesity and metabolic conditions to the next generations are also addressed.
    Experimental Diabetes Research 10/2011; 2011(7579):596060. DOI:10.1155/2011/596060 · 4.33 Impact Factor
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    • "Ferraro and Adamo Clinical Medicine: Pediatrics 2008:2 an overweight/obese child (Pettitt et al. 1983; Petittetal, 1985; Pettitt et al. 1987; Pettitt et al. 1993; Noussitou et al. 2005; Rosenberg et al. 2005; Schaefer-Graf et al. 2005; Malcolm et al. 2006; Allen et al. 2007; Chu et al. 2007; de Campos et al. 2007). The resulting implications of increased maternal adiposity and the corresponding risk this has on the child's future health must be addressed. "
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    ABSTRACT: Global increases in obesity have led public health experts to declare this disease a pandemic. Although prevalent in all ages, the dire consequences associated with maternal obesity have a pronounced impact on the long-term health of their children as a result of the intergenerational effects of developmental programming. Previously, fetal under-nutrition has been linked to the predisposition to pediatric obesity explained by the adiposity rebound and ‘catch-up’ growth that occurs when a child born to a nutrient deprived mother is exposed to the obesogenic environment of present day. Given the recent increase in maternal overweight/obesity (OW/OB) our attention has shifted from nutrient restriction to overabundance and excess during pregnancy. Consideration must now be given to interventions that could mitigate pregravid body mass index (BMI), attenuate gestational weight gain (GWG) and reduce postpartum weight retention (PPWR) in an attempt to prevent the downstream signaling of pediatric obesity and halt the intergenerational cycle of weight related disease currently plaguing our world. Thus, this paper will briefly review current research that best highlights the proposed mechanisms responsible for the development of child OW/OB and related sequalae (e.g. type II diabetes (T2D) and cardiovascular disease (CVD)) resulting from maternal obesity.
    Clinical Medicine: Pediatrics 01/2008;
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