Hyperglycemia and adverse Pregnancy Outcome follow-up study (HAPO FUS): Maternal gestational diabetes mellitus and childhood glucose metabolism

on behalf of the HAPO Follow-up Study Cooperative Research Group*

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423 Scopus citations

Abstract

OBJECTIVE Whether hyperglycemia in utero less than overt diabetes is associated with altered childhood glucose metabolism is unknown. We examined associations of gestational diabetes mellitus (GDM) not confounded by treatment with childhood glycemia in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) cohort. RESEARCH DESIGN AND METHODS HAPO Follow-up Study (FUS) included 4,160 children ages 10–14 years who completed all or part of an oral glucose tolerance test (OGTT) and whose mothers had a 75-g OGTT at ∼28 weeks of gestation with blinded glucose values. The primary predictor was GDM by World Health Organization criteria. Child outcomes were impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes. Additional measures included insulin sensitivity and secretion and oral disposition index. RESULTS For mothers with GDM, 10.6% of children had IGT compared with 5.0% of children of mothers without GDM; IFG frequencies were 9.2% and 7.4%, respectively. Type 2 diabetes cases were too few for analysis. Odds ratios (95% CI) adjusted for family history of diabetes, maternal BMI, and child BMI z score were 1.09 (0.78–1.52) for IFG and 1.96 (1.41–2.73) for IGT. GDM was positively associated with child’s 30-min, 1-h, and 2-h but not fasting glucose and inversely associated with insulin sensitivity and oral disposition index (adjusted mean difference 276.3 [95% CI 2130.3 to 222.4] and 20.12 [20.17 to 20.064]), respectively, but not insulinogenic index. CONCLUSIONS Offspring exposed to untreated GDM in utero are insulin resistant with limited b-cell compensation compared with offspring of mothers without GDM. GDM is significantly and independently associated with childhood IGT.

Original languageEnglish (US)
Pages (from-to)372-380
Number of pages9
JournalDiabetes care
Volume42
Issue number3
DOIs
StatePublished - Mar 1 2019

Funding

The HAPO FUS investigators are grateful for all mothers and children who participated in HAPO and HAPO FUS. The HAPO FUS is funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1U01-DK-094830). The HAPO study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01-HD-34242 and R01-HD-34243). HAPO FUS data were collected and managed using REDCap electronic data capture tools hosted at the Northwestern University Feinberg School of Medicine (FSM). REDCap is supported at FSM by the Northwestern University Clinical and Translational Science Institute. Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences (UL1-TR-001422).

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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