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Impact of Gestational Diabetes Detection Thresholds on Infant Growth and Body Composition: A Prospective Cohort Study
Komal Manerkar1, Caroline A Crowther1, Jane E Harding1
1Liggins Institute, University of Auckland, Auckland, New Zealand.
Insights
Lower gestational diabetes mellitus (GDM) detection thresholds did not increase infant fat mass. Higher GDM thresholds also showed no association with increased infant obesity risk factors.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Endocrinology
Background:
- Gestational diabetes mellitus (GDM) is linked to offspring obesity.
- Causal factors linking GDM to infant metabolic disease require clarification.
Purpose of the Study:
- To evaluate how different GDM detection and treatment thresholds impact infant obesity risk factors.
- To assess the effect of GDM diagnostic criteria on infant body composition, growth, nutrition, and appetite.
Main Methods:
- Prospective cohort study (GEMS trial) comparing lower vs. higher GDM diagnostic criteria.
- Infants were categorized by GDM exposure: untreated, treated with lower criteria, or treated with higher criteria.
- Primary outcome: whole-body fat mass at 5-6 months of age.
Main Results:
- No significant difference in infant fat mass was observed between control infants and those exposed to GDM diagnosed by lower criteria (treated or untreated).
- Infants exposed to GDM detected and treated using higher thresholds also showed no significant difference in fat mass compared to controls.
- Adjusted mean differences in fat mass ranged from -0.09 to -0.17 kg across exposure groups.
Conclusions:
- GDM detection using lower criteria, irrespective of maternal treatment, is not associated with increased infant fat mass.
- Higher GDM diagnostic thresholds, when used for detection and treatment, also do not elevate infant fat mass at 5-6 months.
Objective:
Gestational diabetes mellitus (GDM) is associated with offspring metabolic disease, including childhood obesity, but causal mediators remain to be established. We assessed the impact of lower versus higher thresholds for detection and treatment of GDM on infant risk factors for obesity, including body composition, growth, nutrition, and appetite.
Research Design And Methods:
In this prospective cohort study within the Gestational Diabetes Mellitus Trial of Diagnostic Detection Thresholds (GEMS), pregnant women were randomly allocated to detection of GDM using the lower criteria of the International Association of Diabetes and Pregnancy Study Groups or higher New Zealand criteria (ACTRN12615000290594). Randomly selected control infants of women without GDM were compared with infants exposed to A) GDM by lower but not higher criteria, with usual treatment for diabetes in pregnancy; B) GDM by lower but not higher criteria, untreated; or C) GDM by higher criteria, treated. The primary outcome was whole-body fat mass at 5-6 months.
Results:
There were 760 infants enrolled, and 432 were assessed for the primary outcome. Fat mass was not significantly different between control infants (2.05 kg) and exposure groups: A) GDM by lower but not higher criteria, treated (1.96 kg), adjusted mean difference (aMD) -0.09 (95% CI -0.29, 0.10); B) GDM by lower but not higher criteria, untreated (1.94 kg), aMD -0.15 (95% CI -0.35, 0.06); and C) GDM detected and treated using higher thresholds (1.87 kg), aMD -0.17 (95% CI -0.37, 0.03).
Conclusions:
GDM detected using lower but not higher criteria, was not associated with increased infant fat mass at 5-6 months, regardless of maternal treatment. GDM detected and treated using higher thresholds was also not associated with increased fat mass at 5-6 months.
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