Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity

HAPO Follow-up Study Cooperative Research

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

IMPORTANCE The sequelae of gestational diabetes (GD) by contemporary criteria that diagnose approximately twice as many women as previously used criteria are unclear. OBJECTIVE To examine associations of GD with maternal glucose metabolism and childhood adiposity 10 to 14 years' postpartum. DESIGN, SETTING, AND PARTICIPANTS The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study established associations of glucose levels during pregnancy with perinatal outcomes and the follow-up study evaluated the long-term outcomes (4697 mothers and 4832 children; study visits occurred between February 13, 2013, and December 13, 2016). EXPOSURES Gestational diabetes was defined post hoc using criteria from the International Association of Diabetes and Pregnancy Study Groups consisting of 1 or more of the following 75-g oral glucose tolerance test results (fasting plasma glucose 92 mg/dL; 1-hour plasma glucose level 180 mg/dL; 2-hour plasma glucose level 153 mg/dL). MAIN OUTCOMES AND MEASURES Primary maternal outcome: a disorder of glucose metabolism (composite of type 2 diabetes or prediabetes). Primary outcome for children: being overweight or obese; secondary outcomes: obesity, body fat percentage, waist circumference, and sum of skinfolds (>85th percentile for latter 3 outcomes). RESULTS The analytic cohort included 4697 mothers (mean [SD] age, 41.7 [5.7] years) and 4832 children (mean [SD] age, 11.4 [1.2] years; 51.0% male). The median duration of follow-up was 11.4 years. The criteria for GD were met by 14.3% (672/4697) of mothers overall and by 14.1% (683/4832) of mothers of participating children. Among mothers with GD, 52.2% (346/663) developed a disorder of glucose metabolism vs 20.1% (791/3946) of mothers without GD (odds ratio [OR], 3.44 [95% CI, 2.85 to 4.14]; risk difference [RD], 25.7% [95% CI, 21.7% to 29.7%]). Among children of mothers with GD, 39.5% (269/681) were overweight or obese and 19.1% (130/681) were obese vs 28.6% (1172/4094) and 9.9% (405/4094), respectively, for children of mothers without GD. Adjusted for maternal body mass index during pregnancy, the OR was 1.21 (95% CI, 1.00 to 1.46) for children who were overweight or obese and the RD was 3.7% (95% CI, −0.16% to 7.5%); the OR was 1.58 (95% CI, 1.24 to 2.01) for children who were obese and the RD was 5.0% (95% CI, 2.0% to 8.0%); the OR was 1.35 (95% CI, 1.08 to 1.68) for body fat percentage and the RD was 4.2% (95% CI, 0.9% to 7.4%); the OR was 1.34 (95% CI, 1.08 to 1.67) for waist circumference and the RD was 4.1% (95% CI, 0.8% to 7.3%); and the OR was 1.57 (95% CI, 1.27 to 1.95) for sum of skinfolds and the RD was 6.5% (95% CI, 3.1% to 9.9%). CONCLUSIONS AND RELEVANCE Among women with GD identified by contemporary criteria compared with those without it, GD was significantly associated with a higher maternal risk for a disorder of glucose metabolism during long-term follow-up after pregnancy. Among children of mothers with GD vs those without it, the difference in childhood overweight or obesity defined by body mass index cutoffs was not statistically significant; however, additional measures of childhood adiposity may be relevant in interpreting the study findings.

Original languageEnglish (US)
Pages (from-to)1005-1016
Number of pages12
JournalJAMA - Journal of the American Medical Association
Volume320
Issue number10
DOIs
StatePublished - Sep 11 2018

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Glucose Metabolism Disorders
Gestational Diabetes
Adiposity
Mothers
Odds Ratio
Glucose
Pregnancy
Waist Circumference
Adipose Tissue
Body Mass Index
Obesity
Prediabetic State
Pregnancy Outcome
Glucose Tolerance Test

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{3646b623ba3f4bd5b958cc938e845ef4,
title = "Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity",
abstract = "IMPORTANCE The sequelae of gestational diabetes (GD) by contemporary criteria that diagnose approximately twice as many women as previously used criteria are unclear. OBJECTIVE To examine associations of GD with maternal glucose metabolism and childhood adiposity 10 to 14 years' postpartum. DESIGN, SETTING, AND PARTICIPANTS The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study established associations of glucose levels during pregnancy with perinatal outcomes and the follow-up study evaluated the long-term outcomes (4697 mothers and 4832 children; study visits occurred between February 13, 2013, and December 13, 2016). EXPOSURES Gestational diabetes was defined post hoc using criteria from the International Association of Diabetes and Pregnancy Study Groups consisting of 1 or more of the following 75-g oral glucose tolerance test results (fasting plasma glucose 92 mg/dL; 1-hour plasma glucose level 180 mg/dL; 2-hour plasma glucose level 153 mg/dL). MAIN OUTCOMES AND MEASURES Primary maternal outcome: a disorder of glucose metabolism (composite of type 2 diabetes or prediabetes). Primary outcome for children: being overweight or obese; secondary outcomes: obesity, body fat percentage, waist circumference, and sum of skinfolds (>85th percentile for latter 3 outcomes). RESULTS The analytic cohort included 4697 mothers (mean [SD] age, 41.7 [5.7] years) and 4832 children (mean [SD] age, 11.4 [1.2] years; 51.0{\%} male). The median duration of follow-up was 11.4 years. The criteria for GD were met by 14.3{\%} (672/4697) of mothers overall and by 14.1{\%} (683/4832) of mothers of participating children. Among mothers with GD, 52.2{\%} (346/663) developed a disorder of glucose metabolism vs 20.1{\%} (791/3946) of mothers without GD (odds ratio [OR], 3.44 [95{\%} CI, 2.85 to 4.14]; risk difference [RD], 25.7{\%} [95{\%} CI, 21.7{\%} to 29.7{\%}]). Among children of mothers with GD, 39.5{\%} (269/681) were overweight or obese and 19.1{\%} (130/681) were obese vs 28.6{\%} (1172/4094) and 9.9{\%} (405/4094), respectively, for children of mothers without GD. Adjusted for maternal body mass index during pregnancy, the OR was 1.21 (95{\%} CI, 1.00 to 1.46) for children who were overweight or obese and the RD was 3.7{\%} (95{\%} CI, −0.16{\%} to 7.5{\%}); the OR was 1.58 (95{\%} CI, 1.24 to 2.01) for children who were obese and the RD was 5.0{\%} (95{\%} CI, 2.0{\%} to 8.0{\%}); the OR was 1.35 (95{\%} CI, 1.08 to 1.68) for body fat percentage and the RD was 4.2{\%} (95{\%} CI, 0.9{\%} to 7.4{\%}); the OR was 1.34 (95{\%} CI, 1.08 to 1.67) for waist circumference and the RD was 4.1{\%} (95{\%} CI, 0.8{\%} to 7.3{\%}); and the OR was 1.57 (95{\%} CI, 1.27 to 1.95) for sum of skinfolds and the RD was 6.5{\%} (95{\%} CI, 3.1{\%} to 9.9{\%}). CONCLUSIONS AND RELEVANCE Among women with GD identified by contemporary criteria compared with those without it, GD was significantly associated with a higher maternal risk for a disorder of glucose metabolism during long-term follow-up after pregnancy. Among children of mothers with GD vs those without it, the difference in childhood overweight or obesity defined by body mass index cutoffs was not statistically significant; however, additional measures of childhood adiposity may be relevant in interpreting the study findings.",
author = "{HAPO Follow-up Study Cooperative Research} and Lowe, {William L.} and {Lowe Jr}, {William L} and Scholtens, {Denise M} and Lowe, {Lynn Peterson} and Michael Nodzenski and Octavious Talbot and Catalano, {Patrick M.} and Barbara Linder and Brickman, {Wendy J.} and Brickman, {Wendy Joy} and Chaicharn Deerochanawong and Jill Hamilton and Josefson, {Jami L.} and Josefson, {Jami L} and Lawrence, {Jean M.} and Yael Lebenthal and Ronald Ma and Michael Maresh and David McCance and Tam, {Wing Hung} and Sacks, {David A.} and Dyer, {Alan R.} and Metzger, {Boyd E}",
year = "2018",
month = "9",
day = "11",
doi = "10.1001/jama.2018.11628",
language = "English (US)",
volume = "320",
pages = "1005--1016",
journal = "JAMA - Journal of the American Medical Association",
issn = "0098-7484",
publisher = "American Medical Association",
number = "10",

}

Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. / HAPO Follow-up Study Cooperative Research.

In: JAMA - Journal of the American Medical Association, Vol. 320, No. 10, 11.09.2018, p. 1005-1016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity

AU - HAPO Follow-up Study Cooperative Research

AU - Lowe, William L.

AU - Lowe Jr, William L

AU - Scholtens, Denise M

AU - Lowe, Lynn Peterson

AU - Nodzenski, Michael

AU - Talbot, Octavious

AU - Catalano, Patrick M.

AU - Linder, Barbara

AU - Brickman, Wendy J.

AU - Brickman, Wendy Joy

AU - Deerochanawong, Chaicharn

AU - Hamilton, Jill

AU - Josefson, Jami L.

AU - Josefson, Jami L

AU - Lawrence, Jean M.

AU - Lebenthal, Yael

AU - Ma, Ronald

AU - Maresh, Michael

AU - McCance, David

AU - Tam, Wing Hung

AU - Sacks, David A.

AU - Dyer, Alan R.

AU - Metzger, Boyd E

PY - 2018/9/11

Y1 - 2018/9/11

N2 - IMPORTANCE The sequelae of gestational diabetes (GD) by contemporary criteria that diagnose approximately twice as many women as previously used criteria are unclear. OBJECTIVE To examine associations of GD with maternal glucose metabolism and childhood adiposity 10 to 14 years' postpartum. DESIGN, SETTING, AND PARTICIPANTS The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study established associations of glucose levels during pregnancy with perinatal outcomes and the follow-up study evaluated the long-term outcomes (4697 mothers and 4832 children; study visits occurred between February 13, 2013, and December 13, 2016). EXPOSURES Gestational diabetes was defined post hoc using criteria from the International Association of Diabetes and Pregnancy Study Groups consisting of 1 or more of the following 75-g oral glucose tolerance test results (fasting plasma glucose 92 mg/dL; 1-hour plasma glucose level 180 mg/dL; 2-hour plasma glucose level 153 mg/dL). MAIN OUTCOMES AND MEASURES Primary maternal outcome: a disorder of glucose metabolism (composite of type 2 diabetes or prediabetes). Primary outcome for children: being overweight or obese; secondary outcomes: obesity, body fat percentage, waist circumference, and sum of skinfolds (>85th percentile for latter 3 outcomes). RESULTS The analytic cohort included 4697 mothers (mean [SD] age, 41.7 [5.7] years) and 4832 children (mean [SD] age, 11.4 [1.2] years; 51.0% male). The median duration of follow-up was 11.4 years. The criteria for GD were met by 14.3% (672/4697) of mothers overall and by 14.1% (683/4832) of mothers of participating children. Among mothers with GD, 52.2% (346/663) developed a disorder of glucose metabolism vs 20.1% (791/3946) of mothers without GD (odds ratio [OR], 3.44 [95% CI, 2.85 to 4.14]; risk difference [RD], 25.7% [95% CI, 21.7% to 29.7%]). Among children of mothers with GD, 39.5% (269/681) were overweight or obese and 19.1% (130/681) were obese vs 28.6% (1172/4094) and 9.9% (405/4094), respectively, for children of mothers without GD. Adjusted for maternal body mass index during pregnancy, the OR was 1.21 (95% CI, 1.00 to 1.46) for children who were overweight or obese and the RD was 3.7% (95% CI, −0.16% to 7.5%); the OR was 1.58 (95% CI, 1.24 to 2.01) for children who were obese and the RD was 5.0% (95% CI, 2.0% to 8.0%); the OR was 1.35 (95% CI, 1.08 to 1.68) for body fat percentage and the RD was 4.2% (95% CI, 0.9% to 7.4%); the OR was 1.34 (95% CI, 1.08 to 1.67) for waist circumference and the RD was 4.1% (95% CI, 0.8% to 7.3%); and the OR was 1.57 (95% CI, 1.27 to 1.95) for sum of skinfolds and the RD was 6.5% (95% CI, 3.1% to 9.9%). CONCLUSIONS AND RELEVANCE Among women with GD identified by contemporary criteria compared with those without it, GD was significantly associated with a higher maternal risk for a disorder of glucose metabolism during long-term follow-up after pregnancy. Among children of mothers with GD vs those without it, the difference in childhood overweight or obesity defined by body mass index cutoffs was not statistically significant; however, additional measures of childhood adiposity may be relevant in interpreting the study findings.

AB - IMPORTANCE The sequelae of gestational diabetes (GD) by contemporary criteria that diagnose approximately twice as many women as previously used criteria are unclear. OBJECTIVE To examine associations of GD with maternal glucose metabolism and childhood adiposity 10 to 14 years' postpartum. DESIGN, SETTING, AND PARTICIPANTS The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study established associations of glucose levels during pregnancy with perinatal outcomes and the follow-up study evaluated the long-term outcomes (4697 mothers and 4832 children; study visits occurred between February 13, 2013, and December 13, 2016). EXPOSURES Gestational diabetes was defined post hoc using criteria from the International Association of Diabetes and Pregnancy Study Groups consisting of 1 or more of the following 75-g oral glucose tolerance test results (fasting plasma glucose 92 mg/dL; 1-hour plasma glucose level 180 mg/dL; 2-hour plasma glucose level 153 mg/dL). MAIN OUTCOMES AND MEASURES Primary maternal outcome: a disorder of glucose metabolism (composite of type 2 diabetes or prediabetes). Primary outcome for children: being overweight or obese; secondary outcomes: obesity, body fat percentage, waist circumference, and sum of skinfolds (>85th percentile for latter 3 outcomes). RESULTS The analytic cohort included 4697 mothers (mean [SD] age, 41.7 [5.7] years) and 4832 children (mean [SD] age, 11.4 [1.2] years; 51.0% male). The median duration of follow-up was 11.4 years. The criteria for GD were met by 14.3% (672/4697) of mothers overall and by 14.1% (683/4832) of mothers of participating children. Among mothers with GD, 52.2% (346/663) developed a disorder of glucose metabolism vs 20.1% (791/3946) of mothers without GD (odds ratio [OR], 3.44 [95% CI, 2.85 to 4.14]; risk difference [RD], 25.7% [95% CI, 21.7% to 29.7%]). Among children of mothers with GD, 39.5% (269/681) were overweight or obese and 19.1% (130/681) were obese vs 28.6% (1172/4094) and 9.9% (405/4094), respectively, for children of mothers without GD. Adjusted for maternal body mass index during pregnancy, the OR was 1.21 (95% CI, 1.00 to 1.46) for children who were overweight or obese and the RD was 3.7% (95% CI, −0.16% to 7.5%); the OR was 1.58 (95% CI, 1.24 to 2.01) for children who were obese and the RD was 5.0% (95% CI, 2.0% to 8.0%); the OR was 1.35 (95% CI, 1.08 to 1.68) for body fat percentage and the RD was 4.2% (95% CI, 0.9% to 7.4%); the OR was 1.34 (95% CI, 1.08 to 1.67) for waist circumference and the RD was 4.1% (95% CI, 0.8% to 7.3%); and the OR was 1.57 (95% CI, 1.27 to 1.95) for sum of skinfolds and the RD was 6.5% (95% CI, 3.1% to 9.9%). CONCLUSIONS AND RELEVANCE Among women with GD identified by contemporary criteria compared with those without it, GD was significantly associated with a higher maternal risk for a disorder of glucose metabolism during long-term follow-up after pregnancy. Among children of mothers with GD vs those without it, the difference in childhood overweight or obesity defined by body mass index cutoffs was not statistically significant; however, additional measures of childhood adiposity may be relevant in interpreting the study findings.

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DO - 10.1001/jama.2018.11628

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JF - JAMA - Journal of the American Medical Association

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