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Birth Weight and Parental BMI Predict Overweight in Children from Mothers with Gestational Diabetes

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Birth Weight and Parental BMI Predict Overweight in Children from Mothers with Gestational Diabetes Pathophysiology/Complications ORIGINAL ARTICLE Birth Weight and Parental BMI Predict Overweight in Children From Mothers With Gestational Diabetes 1 4 UTE M. SCHAEFER-GRAF, MD CHRISTOPH B¨UHRER, MD gestational-age newborns. Clinical and 1 5 JULIA PAWLICZAK THOMAS HARDER, MD, MSCE experimental studies have shown that the 1 5 DOERTE PASSOW ANDREAS PLAGEMANN, MD 2 1 implications of fetal hyperinsulinism REINHARD HARTMANN, MD KLAUS VETTER, MD 3 2 reach far beyond delivery. Children of RAINER ROSSI, MD OLGA KORDONOURI, MD mothers with diabetes in pregnancy may develop an increased disposition for obe- sity and glucose intolerance through a nongenetic “fuel-mediated” mechanism (1–8). OBJECTIVE — To investigate the growth of children from pregnancies with gestational dia- betes mellitus (GDM) and its association with antenatal maternal, fetal, and recent anthropo- Disposition for obesity could be influ- metric parameters of mother and father. enced by many factors other than mater- nal diabetes in pregnancy. To our RESEARCH DESIGN AND METHODS — In 324 pregnancies of Caucasian women knowledge, there are no studies that eval- with GDM, BMI before pregnancy, maternal glycemic values, and measurements of the fetal uate the contribution of maternal hyper- abdominal circumference were recorded. The weight and height of infants were measured at glycemia to childhood overweight in birth and at follow-up at 5.4 years (range 2.5–8.5). In addition, somatic data from routine comparison to other antepartum mater- examinations at 6, 12, and 24 months and the BMI of parents at follow-up were obtained. BMI nal and fetal confounders and the influ- standard deviation scores (SDSs) were calculated based on age-correspondent data. ence of the postnatal environment. The RESULTS — At all time points, BMI was significantly above average (ϩ0.82 SDS at birth; present large longitudinal study of infants ϩ0.56 at 6, ϩ0.35 at 12, and ϩ0.32 at 24 months; and ϩ0.66 at follow-up; P Ͻ 0.001). BMI at of mothers treated for GDM aimed to birth was related to BMI at follow-up (r ϭ 0.27, P Ͻ 0.001). The rate of overweight at follow-up evaluate the association of the level of ma- was 37% in children with birth BMI Ն90th percentile and 25% in those with normal BMI at birth ternal hyperglycemia during pregnancy, (P Ͻ 0.05). Abdominal circumference of third trimester and postprandial glucose values were fetal (as assessed by ultrasound) and neo- related to BMI at follow-up (r ϭ 0.22 and r ϭ 0.18, P Ͻ 0.01). Recent maternal, paternal, and natal obesity, and childhood obesity, as birth BMI were independent predictors of BMI at follow-up (r ϭ 0.42, P Ͻ 0.001). Sixty-nine well as maternal and paternal obesity in 2 percent of children of parents with BMI Ն30 kg/m were overweight at follow-up compared with pregnancies complicated by GDM. 20% of those with parental BMI Ͻ30 kg/m2 (P Ͻ 0.001). CONCLUSIONS — Children of mothers with GDM have a high rate of overweight that is RESEARCH DESIGN AND associated both with intrauterine growth and parental obesity. METHODS — The study cohort was Diabetes Care 28:1745–1750, 2005 recruited from children of mothers who had GDM and attended the Diabetes Pre- natal Care Clinic of the Department of Obstetrics at the Vivantes Medical Center estational diabetes mellitus (GDM) to fetal hyperinsulinism. Stimulation of Berlin, a tertiary community hospital, reflects a metabolically altered fetal the insulin-sensitive tissue results in in- from 1995 through 2000. The infants G environment due to an increased creased fetal growth, predominantly of were selected from an ongoing database maternal supply of carbohydrates leading the abdomen, and delivery of large-for- where clinical, glycemic, fetal ultrasound, ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● and delivery data of all women attending From the 1Department of Obstetrics, Vivantes Medical Center Neuko¨lln, Berlin, Germany; the 2Department 3 the clinic were prospectively entered. In- of Pediatrics, Charite´ University Medical Center Campus Virchow-Klinikum, Berlin, Germany; the Depart- clusion criteria were as follows: 1) at least ment of Pediatrics, Vivantes Medical Center Neuko¨lln, Berlin, Germany; the 4University Children’s Hospital, Basel, Switzerland; the 5Department of Obstetrics, Charite´ University Medical Center Campus Virchow- one maternal glucose profile after diagno- Klinikum, Berlin, Germany. sis of GDM, 2) availability of data regard- Address correspondence and reprint requests to Ute M. Schaefer-Graf, MD, PhD, Department of Obstet- ing maternal obstetrical history and rics, Vivantes Medical Center Berlin-Neuko¨lln, Rudower Straße 48, D-12351 Berlin, Germany. E-mail: anthropometry, 3) singleton pregnancy, [email protected]. Received for publication 20 January 2005 and accepted in revised form 10 April 2005. 4) accurate gestational age at delivery con- Abbreviations: GDM, gestational diabetes mellitus; OGTT, oral glucose tolerance test; SDS, standard firmed by an ultrasound examination be- deviation score. fore 20 weeks of gestation, 5) at least one A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion complete fetal biometry after diagnosis of factors for many substances. GDM, and 6) age Ն2 years at the time of © 2005 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby study. The study protocol was approved marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. by the institutional review board. In- DIABETES CARE, VOLUME 28, NUMBER 7, JULY 2005 1745 Overweight in children of mothers with GDM formed written consent was obtained weight was measured using a digital scale and for average values of fasting and 2-h from the parents. (Soehnle, Murrhardt, Germany) to the postprandial glucose measurements dur- nearest 0.1 kg, and standing height was ing gestational weeks 28–40. Finally, Diabetes care measured with a wall-mounted stadiom- stepwise multivariate linear regression anal- Diagnosis of GDM was established by a eter (Sena, Witten, Germany). Additionally, ysis was performed to determine indepen- 75-g oral glucose tolerance test (OGTT) the actual weight and height of mother dent predictors of BMI at follow-up. with determination of capillary blood glu- and father were obtained, and the BMI was cose levels using a glucose oxidase calculated. RESULTS — A total of 771 children method (Beckman Glucose Analyzer, Furthermore, prior anthropometric qualified for the study. Between May Brea, CA). Diagnostic criteria for GDM data were retrospectively obtained from 2003 and January 2004, examinations valid in Germany at the time of study were routine examinations at 6, 12, and 24 were performed on 324 children (54.0% fasting blood glucose Ն90 mg/dl (5.0 months, which are offered to all children boys, 46.0% girls). The remaining fami- mmol/l), 1-h blood glucose Ն165 mg/dl within the German health care system. The lies either did not respond (n ϭ 322) or (9.1 mmol/l), and 2-h blood glucose examinations were performed by outside were not interested in an examination of Ն145 mg/dl (8.0 mmol/l) (9). Diagnosis pediatricians and documented in a special their child (n ϭ 125). Antenatal maternal, of GDM required at least two abnormal booklet given to parents at delivery. fetal, or neonatal data of the children values. Testing had been performed selec- without follow-up examination were not tively in women with risk factors for Data analysis significantly different from those who GDM. Birth weight and BMI were transformed could be examined. After GDM diagnosis, women were into percentiles according to gestational Ϫ Ϫ put on a 25– to 30–kcal ⅐ kg 1 ⅐ day 1 age at delivery (11). Large-for-gesta- Neonatal and childhood BMI diet based on their prepregnancy weights. tional-age birth weight was assessed on The rate of large-for-gestational-age new- All women were taught self-monitoring of the basis of BMI Ն90th percentile. The borns was 17.0%, while 7.1% of the blood glucose by performing daily glu- standard deviation score (SDS) of BMI at newborns had a birth weight Ͻ10th per- cose profiles (three preprandial and three follow-up examinations was calculated centile. Birth BMI Ն90th percentile was 2-h postprandial measurements) twice by Cole’s transformation using age- found in 30.9% of the newborns and a per week or daily if insulin therapy was correspondent data of a normal German BMI Ͻ10th percentile in 4.6%. Mean ges- required, respectively, using memory- population (12). Overweight in child- tational age at delivery was 39.2 Ϯ 1.5 based glucometers (Roche Diagnostics, hood was defined as BMI Ն90th percen- weeks. Grenzach-Wyhlen, Germany). Insulin tile (12,13). BMI was analyzed in the total The mean age at follow-up was 5.4 Ϯ therapy was initiated when either the group and separately in children with age 1.6 years (range 2.5–8.5). Of the chil- mean of all capillary glucose values of a less than and Ն6 years using t test or Wil- dren, 40.4% were at least 6 years old. At profile exceeded 100 mg/dl (5.5 mmol/l) coxon and Kruskal-Wallis when appro- follow-up, a BMI Ͼ90th percentile was or fasting glucose exceeded 95 mg/dl (5.3 priate. The Kolmogoroff-Smirnov test found in 92 of 324 children (28.4%) mmol/l) and/or when 2-h postprandial was used to assess BMI deviation from without significant difference in sex or age values exceeded 120 mg/dl (6.6 mmol/l) normal population. Differences between at follow-up (Table 1). The highest BMI after a 2-week trial of diet.
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