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Untreated Mild Hyperglycemia During Pregnancy and Anthropometric Measures of Obesity in Offspring at Age 5-7 Years
Parag K Thaware1, Sonia McKenna2, Christopher C Patterson3
1Royal Victoria Hospital, Belfast, U.K. Queen's University Belfast, Belfast, U.K.
Insights
Maternal hyperglycemia during pregnancy, even without diabetes, does not increase offspring obesity risk. This finding holds true after accounting for maternal body mass index (BMI) at the oral glucose tolerance test (OGTT).
Area of Science:
- Reproductive Endocrinology
- Pediatric Endocrinology
- Metabolic Disorders
Background:
- Previous studies suggest a link between maternal hyperglycemia during pregnancy and offspring obesity.
- Conflicting results exist regarding the strength and nature of this association.
- The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study provides a robust dataset to investigate this relationship.
Purpose of the Study:
- To examine the association between maternal hyperglycemia during pregnancy and offspring anthropometry.
- To determine if maternal glucose levels during gestation predict childhood obesity (ages 5-7 years).
- To clarify the role of maternal pre-pregnancy BMI in this association.
Main Methods:
- Mothers from the HAPO Study in Belfast underwent an oral glucose tolerance test (OGTT) at ~28 weeks gestation.
- Offspring anthropometry (weight, height, skinfold thickness) was measured at 5-7 years of age.
- Multiple regression analysis was used, adjusting for maternal BMI at OGTT and offspring birth weight z-score.
Main Results:
- Maternal fasting plasma glucose (FPG), 1-hour plasma glucose (1h PG), and 2-hour plasma glucose (2h PG) were not associated with offspring BMI z-score or skinfold sum.
- This lack of association persisted when defining offspring overweight, obesity, or extreme obesity using BMI z-scores.
- The initially observed relationship between maternal FPG and offspring adiposity was fully explained by maternal BMI at the time of the OGTT.
Conclusions:
- Higher maternal FPG concentration during pregnancy, below the threshold for diabetes, is not an independent risk factor for offspring obesity.
- Maternal BMI at the time of the OGTT is a significant confounder in the relationship between maternal glycemia and offspring adiposity.
- These findings suggest that interventions targeting maternal weight may be more effective in preventing childhood obesity related to pregnancy glucose metabolism.
Objective:
Obesity in the offspring of women with hyperglycemia during pregnancy has been reported, but the results are conflicting. This study examined the association of hyperglycemia during pregnancy and anthropometry in 5- to 7-year-old offspring whose mothers participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study at the Belfast Centre.
Research Design And Methods:
Women in the HAPO study underwent a 75-g oral glucose tolerance test (OGTT) at approximately 28 weeks of gestation. Mothers and caregivers remained blinded to the results unless the fasting plasma glucose (FPG) concentration was >5.8 mmol/L or the 2-h plasma glucose (2hPG) concentration was >11.1 mmol/L. Offspring weight, height, and skinfold thicknesses (triceps, subscapular, and suprailiac) were measured at age 5-7 years. Overweight, obesity, and extreme obesity were defined as a BMI z score ≥85th, ≥95th, and ≥99th percentile, respectively, based on the 1990 British Growth Standard.
Results:
Belfast HAPO offspring (n = 1,320, 82%) aged 5-7 years attended for follow-up. With use of multiple regression, maternal FPG, 1h PG, and 2hPG did not show any relation to offspring BMI z score or offspring skinfold sum independent of maternal BMI at OGTT and offspring birth weight z score. This lack of association with maternal glycemia persisted with the offspring BMI z score expressed as ≥85th, ≥95th, or 99th percentile and the sum of skinfolds expressed as ≥90th percentile specific for sex. The initially significant relation between FPG and all offspring adiposity measures was explained by maternal BMI at the OGTT.
Conclusions:
After adjustment for maternal BMI at the OGTT, higher maternal FPG concentration during pregnancy (short of diabetes) is no longer a risk factor for obesity, as reflected by BMI and the sum of skinfolds in offspring aged 5-7 years.
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