Gestational Glucose Intolerance and Risk of Obesity in Childhood and Adolescence

An association between in utero exposure to gestational glucose intolerance (GGI; abnormal glucose screening without gestational diabetes) and offspring obesity has not been consistently observed.

In a retrospective cohort, we studied the risk of obesity [body mass index (BMI) ≥ 95th percentile], in 2- to 5, 6- to 10-, and 11- to 18-year-olds exposed to varying degrees of maternal glycemia in utero: normal glucose tolerance (NGT), GGI [0 abnormal glucose values or 1 abnormal value (GGI-1)] or gestational diabetes (GDM; ≥2 of 4 abnormal values). We used generalized estimating equations for logistic regression to estimate odds ratios for obesity in each glycemic category compared to NGT, adjusting for maternal age, parity, insurance, race/ethnicity, marital status, infant sex, gestational age, and gestational weight gain. A second model additionally adjusted for maternal first-trimester BMI.

We included 27 876 children and adolescents from 23 334 (83.7%) NGT pregnancies, 3413 (12.2%) GGI pregnancies, and 1129 (4.1%) GDM pregnancies. The prevalence of obesity was 13.5% at age 2 to 5, 20.3% at age 6 to 10, and 23.4% at age 11 to 18. Those exposed to GGI-1 and GDM had increased odds of obesity compared to NGT. Adjusting for maternal BMI attenuated this association in all age and glycemic exposure groups, but it remained significantly elevated in 6- to 10-year-olds exposed to GDM [odds ratio (OR): 1.21, 95% confidence interval (CI) 1.01, 1.46] and 11- to 18-year-olds exposed to GGI-1 and GDM (GGI-1 OR: 1.44 (95% CI 1.14, 1.81); GDM OR: 1.28 (95% CI 1.03, 1.59)].

Older children and adolescents exposed to GGI-1 and GDM in utero have a higher risk of obesity than those born to NGT pregnancies, even after accounting for maternal BMI.