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Gestational Diabetes But Not Prepregnancy Overweight Predicts for Cardiometabolic Markers in Offspring Twenty Years
Nina Kaseva1, Marja Vääräsmäki1,2, Jouko Sundvall1
1National Institute for Health and Welfare, Helsinki, Finland.
Insights
Adults born to mothers with gestational diabetes mellitus (GDM) show higher insulin resistance and poorer lipid profiles. Maternal prepregnancy overweight/obesity also impacts offspring glucose regulation, with effects partly explained by current adiposity.
Area of Science:
- Cardiovascular disease epidemiology
- Metabolic health research
- Maternal-fetal medicine
Background:
- Maternal gestational diabetes mellitus (GDM) and prepregnancy overweight/obesity are potential risk factors for adverse offspring cardiometabolic health.
- Understanding these long-term effects is crucial for preventative strategies.
Purpose of the Study:
- To investigate the associations between maternal GDM and prepregnancy overweight/obesity with cardiometabolic risk factors in adult offspring.
- To differentiate the impacts of GDM versus maternal overweight/obesity on offspring health.
Main Methods:
- Longitudinal cohort study (ESTER and Arvo Ylppö studies) in Finland.
- Classification of offspring based on maternal history: GDM (OGDM), normoglycemic with overweight/obesity (ONO), and controls.
- Assessment of cardiometabolic biomarkers, blood pressure, and heart rate in adult offspring (mean age 24.1 years).
Main Results:
- Offspring of mothers with GDM (OGDM) exhibited lower Sex Hormone-Binding Globulin (SHBG), high-density lipoprotein (HDL), and apolipoprotein A1, independent of confounders or offspring adiposity.
- Both OGDM and ONO groups showed higher fasting glucose and insulin, but these differences were attenuated after adjustments.
- No significant differences in heart rate or other biomarkers were observed between groups.
Conclusions:
- Maternal GDM is associated with increased markers of insulin resistance and an atherogenic lipid profile in adult offspring, partly independent of offspring adiposity.
- Maternal prepregnancy overweight/obesity is linked to impaired offspring glucose regulation, primarily explained by current adiposity.
- These findings highlight the lasting impact of maternal metabolic health during pregnancy on offspring cardiometabolic outcomes.
Context:
Maternal gestational diabetes mellitus (GDM) and prepregnancy overweight/obesity [body mass index (BMI) ≥25 kg/m2] might adversely affect offspring cardiometabolic health.
Objective:
To assess the associations between maternal GDM and prepregnancy overweight/obesity with adult offspring cardiometabolic risk factors.
Design:
Longitudinal cohort study (ESTER Maternal Pregnancy Disorders Study and the Arvo Ylppö Longitudinal Study).
Setting:
Province of Uusimaa and Northern Finland.
Participants:
At a mean age of 24.1 ± 1.3 years, we classified offspring as offspring of mothers with GDM regardless of the prepregnancy BMI (OGDM; n = 193); normoglycemic mothers with prepregnancy overweight/obesity (ONO; n = 157); and normoglycemic mothers with prepregnancy BMI <25 kg/m2 (controls; n = 556).
Main Outcome Measures:
We assessed the cardiometabolic biomarkers from blood and measured the blood pressure at rest and heart rate.
Results:
Compared with the controls, the OGDM and ONO groups had greater fasting glucose (1.6%; 95% CI, 0.1% to 3.1%; and 2.3%; 95% CI, 0.5% to 4.3%, respectively) and insulin (12.7%; 95% CI, 4.4% to 21.9%; and 8.7%; 95% CI, 0.2% to 17.8%). These differences attenuated to nonsignificance when adjusted for confounders and/or current offspring characteristics, including BMI or body fat percentage. The OGDM group had lower SHBG (men, -12.4%; 95% CI, -20.2% to -3.9%; women, -33.2%; 95% CI, -46.3% to -16.8%), high-density lipoprotein (-6.6%; 95% CI, -10.9% to -2.2%), and apolipoprotein A1 (-4.5%; 95% CI, -7.5% to -1.4%). These differences survived the adjustments. The heart rate and other biomarkers were similar among the groups.
Conclusions:
Adult offspring of mothers with GDM have increased markers of insulin resistance and a more atherogenic lipid profile. These were only partly explained by confounders or current offspring adiposity. Maternal prepregnancy overweight/obesity was associated with impaired offspring glucose regulation, which was explained by confounders and/or current adiposity.
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