Gestational diabetes and childhood lung function at age 8 to 9 years in a diverse US cohort

Gestational diabetes mellitus (GDM) is associated with systemic processes that may disrupt fetal development and contribute to suboptimal lung function in offspring. Distinct from respiratory conditions such as asthma, lung function is a broad indicator of respiratory health and is predictive of long-term health outcomes. GDM has previously been associated with childhood asthma, but studies on childhood lung function are sparse.

To evaluate the association between GDM and respiratory outcomes in children, including lung function, wheeze, and asthma.

We studied mother-child dyads enrolled in a prospective pregnancy cohort (births 2007-2011) and followed to child age 8 to 9 years. We assessed GDM by chart review and measured child lung function using spirometry, characterizing the following outcomes: forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), FEV₁/FVC, and forced expiratory flow between 25% and 75% of vital capacity (FEF_25-75) (n = 722). We used multiple linear regression to evaluate associations between GDM and lung function z-scores. Then, we assessed child current asthma and wheeze by questionnaire (n = 892) and evaluated their association with GDM using multivariable logistic regression.

GDM was identified in 6% of pregnancies. In children, median (IQR) FEV₁, FVC, FEV₁/FVC, and FEF_25-75 z-scores were -0.47 (-1.14, 0.22), -0.41 (-1.11, 0.31), -0.08 (-0.83, 0.61), and -0.34 (-1.02, 0.38), respectively. With adjustment, GDM-exposed children had lower FEV₁ (β = -0.28 [95% CI: -0.55, -0.00]) and FEF_25-75 (β = -0.43 [95% CI: -0.76, -0.10]) and increased odds of current asthma (odds ratio = 3.12 [95% CI: 1.55, 6.28]) compared with unexposed children. We observed no differences in other lung function measures.

GDM may be a risk factor for decreased lung function and childhood asthma.