Gestational Diabetes Outcome in a Single Center Study: Higher BMI in Children After Six Months

Abstract

The aim of the study was to examine obstetric outcomes and metabolic disorders in patients with gestational diabetes mellitus (GDM) and their offspring compared to mothers without GDM and their offspring. We performed a retrospective single center cohort study of mothers with GDM using a questionnaire with items concerning the maternal medical history, neonatal complications, and child development. Mothers with gestational diabetes (GDM; n=130) and those with normal glucose tolerance (NGT; n=77) were recruited. GDM mothers were older (37.58 years vs. 34.32 years, p<0.0001) and had a greater body mass index (25.18 kg/m² vs. 23.37 kg/m², p<0.01). There were no significant differences regarding the mean birth weight, the frequency of Cesarean sections, and the prevalence of macrosomia (> 4 000 g). At follow-up (pediatric U5 screening visit after 6 months of birth) children of mothers with GDM had significantly higher BMI than the children of the NGT group (17.07 kg/m² vs. 16.59 kg/m², p=0.042). GDM women in need of insulin therapy during pregnancy had higher BMI than dieting GDM mothers and experienced more frequently an operative vaginal delivery (17.95% vs. 6.17%, OR 3.23, p=0.04). We found less significant differences between GDM mothers with treatment of impaired glucose tolerance and NGT mothers concerning the neonatal outcome than expected. Despite higher BMI of the GDM group’s offspring at follow-up U5 visit, the children did not show any other development disorder. In conclusion treatment of GDM could minimize the frequency of obstetric and neonatal complications in this risk group.

Key words

body mass index - metabolic syndrome in childhood - insulin in pregnancy

• References

• 1 O’Sullivan JB. Diabetes mellitus after GDM. Diabetes 1991; 40 (Suppl. 02) 131-135
• 2 Feig DS, Zinman B, Wang X, Hux JE. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ 2008; 179: 229-234
• 3 Rosenberg TJ, Garbers S, Lipkind H, Chiasson MA. Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups. Am J Public Health 2005; 95: 1545-1551
• 4 Gilbert JA, Dunlop DM. Diabetic fertility, maternal mortality, and foetal loss rate. Br Med J 1949; 1: 48-51
• 5 Langer O, Mazze R. The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes. Am J Obstet Gynecol 1988; 159: 1478-1483
• 6 Kieffer EC, Alexander GR, Kogan MD, Himes JH, Herman WH, Mor JM, Hayashi R. Influence of diabetes during pregnancy on gestational age-specific newborn weight among US black and US white infants. Am J Epidemiol 1998; 147: 1053-1061
• 7 Langer O, Berkus MD, Huff RW, Samueloff A. Shoulder dystocia: Should the fetus weighing ≥4000 grams be delivered by cesarean section?. Am J Obstet Gynecol 1991; 165: 831-837
• 8 Persson B, Hanson U. Neonatal morbidities in gestational diabetes mellitus. Diabetes Care 1998; B79-B84
• 9 Wroblewska-Seniuk K, Wender-Ozegowska E, Szczapa J. Long-term effects of diabetes during pregnancy on the off-spring. Pediatr Diabetes 2009; 10: 432-440
• 10 http://www.crescnet.org/wissenschaft.php#anfang (Access: October 11 2010)
• 11 Boney CM, Verma A, Tucker R, Vohr BR. Metabolic Syndrome in Childhood: Association with Birth Weight, Maternal Obesity and Gestational Diabetes Mellitus. Pediatrics 2005; 115: e290-e296
• 12 Schaefer-Graf U, Pawliczak J, Passow D, Hartmann R, Rossi R, Bührer C, Harder T, Plagemann A, Vetter K, Kordonouri O. Birth Weight and Parental BMI predict overweight in Children from Mothers with Gestational Diabetes. Diabetes Care 2005; 28: 1745-1750
• 13 Tam WH, Ma RC, Yang X, Ko GT, Tong PC, Cockram CS, Sahota DS, Rogers MS, Chan JC. Glucose Intolerance and Cardiometabolic Risk in Children Exposed to Maternal Gestational Diabetes Mellitus in Utero. Pediatrics 2008; 122: 1229-1234
• 14 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144: 768-773
• 15 Hessische Fachvereinigung für Diabetes e. V. (HFD). Tätigkeitsbericht. 2003 http://www.med.uni-giessen.de/hfd/pdf/2003.pdf page 3
• 16 The HAPO Study Cooperative Research, Group . Hyperglycemia and Adverse Pregnancy Outcomes. N Engl J Med 2008; 358: 1991-2002
• 17 Schäfer-Graf U. Empfehlungen zu Diagnostik und Therapie des Gestationsdiabetes (GDM). Arbeitsgemeinchaft Diabetes und Schwangerschaft der Deutschen Diabetes Gesellschaft(DDG), Arbeitsgemeinschaft für materno-fetale Medizin (AGMFM) der Deutschen Gesellschaft. Geburtsh Frauenheilk 2004; 64: 125-133
• 18 http://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Leitlinien/Evidenzbasierte_Leitlinien/Gestationsdiabetes_EbLL_Endfassung_2011_08_11_.pdf (reported on 28 Jan 2014)
• 19 Hedderson MM, Darbinian JA, Ferrara A. Disparities in the risk of gestational diabetes by race-ethnicity and country of birth. Pediatr Perinat Epidemiol 2010; 24: 441-448
• 20 Weight Gain During Pregnancy . Reexamining the Guidelines. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Rasmussen KM, Yaktine AL. (eds) Washington DC: National Academic Press (US); 2009
• 21 Rasmussen B, Dunning T, Hendrieckx C, Botti M, Speight J. Transition to motherhood in type 1 diabetes: design of the pregnancy and postnatal well-being in transition questionnaires. BMC Pregnancy Childbirth 2013; 27 13: 54
• 22 Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet Med 2004; 21: 103-113
• 23 Vambergue A, Dognin C, Boulogne A, Réjou MC, Biausque S, Fontaine P. Increasing incidence of abnormal glucose tolerance in women with prior abnormal glucose tolerance during pregnancy: DIAGEST 2 study. Diabet Med 2008; 25: 58-64
• 24 Füchtenbusch M, Ferber K, Standl E, Ziegler AG. Prediction of type 1 diabetes postpartum in patients with gestational diabetes mellitus by combined islet cell autoantibody screening: a prospective multicenter study. Diabetes 1997; 46: 1459-1467
• 25 Weng J, Ekelund M, Lehto M, Li H, Ekberg G, Frid A, Aberg A, Groop LC, Berntorp K. Screening for MODY mutations, GAD antibodies, and type 1 diabetes-associated HLA genotypes in women with gestationa diabetes melitus. Diabetes Care 2002; 25: 68-71
• 26 Järvelä IY, Juutinen J, Koskela P, Hartikainen AL, Kulmala P, Knip M, Tapanainen JS. Gestational diabetes identifies women at risk for permanent type 1 and type 2 diabetes in fertile age: predictive role of antibodies. Diabetes Care 2006; 29: 607-612
• 27 Albareda M, Caballero A, Badell G, Piquer S, Ortiz A, de Leiva A, Corcoy R. Diabetes and abnormal glucose tolerance in women with previous gestational diabetes. Diabetes Care 2003; 26: 1199-1205
• 28 Pallardo F, Herranz L, Garcia-Ingelmo T, Grande C, Martin-Vaquero P, Jañez M, Gonzalez A. Early postpartum metabolic assessment in women with prior gestational diabetes. Diabetes Care 1999; 22: 1053-1058
• 29 Ekelund M, Shaat N, Almgren P, Groop L Berntorp Prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetologia 2010; 53: 452-457
• 30 Haver MC, Locksmith GJ, Emmet E. Irregular menses: an independant risk factor for gestational diabetes mellitus. Am J Obstet Gynecol 2003; 188: 1189-1191
• 31 Saydah SH, Chandra A, Eberhardt MS. Pregnancy experience among women with and without gestational diabetes in the US 1995 National Survey of Family Growth.
• 32 Crane JP, Wahl N. The role of maternal diabetes in repetitive spontaneous abortion. Fertil Steril 1981; 36: 477-479
• 33 Yang H, Wei Y, Gao X, Xu X, Fan L, He J, Hu Y, Liu X, Chen X, Yang Z, Zhang C. China National GDM Survey Working Group . Risk factors for gestational diabetes mellitus in Chinese women: a prospective study of 16286 pregnant women in China. Diabet Med 2009; 26: 1099-1104
• 34 Salzberger M, Liban E. Diabetes and antenatal fetal death. Isr J Med Sci 1975; 11: 623-628
• 35 Patel RR, Peters TJ. Prenatal risk factors for Cesarean section. Analyses of the ALSPAC cohort of 12944 women in England. Int J Epidemio 2005; 34: 353-367
• 36 Naylor CD, Sermer M, Chen E, Sykora K. Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators. JAMA 1996; 275: 1165-1170
• 37 Bhat M, Ramesha KM, Sarma Sankara P, Menon S, Ganesh KS. Outcome of Gestational Diabetes Mellitus from a Tertiary Referral Center in South India: A Case-Control Study. J Obst Gynecol India 2012; 62: 644-649
• 38 Remsberg KE, McKeown RE, McFarland KF, Irwin LS. Diabetes in pregnancy and cesarean delivery. Diabetes Care 1999; 22: 1561-1567
• 39 Jensen DM, Sorensen B. Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar risk. Diabet Med 2000; 17: 281-286
• 40 Faktencheck Gesundheit Kaiserschnitt-Bertelsmann-Stiftung. Caesarean sections in Germany: Marked increase and wide regional variations. Nearly one in three children are born by caesarean section. (Online, reported on 28 Jan 2014) https://faktencheck-gesundheit.de/fileadmin/daten_fcg/Dokumente/130828_Themenblatt_ENGLISCH_Kaiserschnitt.pdf
• 41 Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp Jr JM, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network . A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes. N Engl J Med 2009; 361: 1339-1348
• 42 Persson M, Fadl H, Hanson U, Pasupathy D. Disproportionate body composition and neonatal outcome in offspring of mothers with and without gestational diabetes mellitus. Diabetes Care 2013; 36: 3543-3548
• 43 Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among US Adolescents, 1999–2000. Diabetes Care 2004; 27: 2438-2443
• 44 Kaufman FR. Type 2 diabetes in children and youth. Endocrinol Metab Clin North Am 2005; 34: 659-676 ix–x
• 45 Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007; 30: 2287-2292
• 46 Catalano PM, Farrell K, Thomas A, Huston-Presley L, Mencin P, de Mouzon SH, Amini SB. Perinatal risk factors for childhood obesity and metabolic dysregulation. Am J Clin Nutr 2009; 90: 1303-1313
• 47 Bouchard L. Epigenetics and fetal metabolic programming: a call for integrated research on larger cohorts. Diabetes 2013; 62: 1026-1028
• 48 El Hajj N, Pliushch G, Schneider E, Dittrich M, Müller T, Korenkov M, Aretz M, Zechner U, Lehnen H, Haaf T. Metabolic programming of MEST DNA methylation by intrauterine exposure to gestational diabetes mellitus. Diabetes 2013; 62: 1320-1328