BACKGROUND AND PURPOSE:

• Gestational Diabetes Mellitus (GDM) screening (see ‘Related ObG Topics’ below)
  • The Carpenter-Coustan criteria entails a ‘2 step’ approach to the diagnosis of GDM
  • Another method is the 1 step approach which will diagnose twice as many women compared to the ‘2 step’ approach
• Lowe et al. (JAMA 2018) sought to determine whether GDM is associated with maternal glucose metabolism and offspring adiposity

METHODS:

• Population based study
• Follow up study of The Hyperglycemia and Adverse Pregnancy Outcome (HAPO)
  • 75-g oral glucose tolerance test administered at approximately 28 weeks
  • Fasting plasma glucose level and 1-hour and 2-hour plasma glucose levels were measured
  • The study evaluated perinatal/ long-term outcomes and associations with pregnancy glucose levels
• GDM definition for this study: ‘Post hoc’ diagnosis using criteria from the International Association of Diabetes and Pregnancy Study Groups (IADPSG) 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
• Primary outcomes
  • Maternal outcome: A disorder of glucose metabolism
  • Children outcomes: Overweight or obese
• Secondary outcomes in children
  • Obesity | Body fat percentage | Waist circumference | Sum of skinfolds

RESULTS:

• 4,697 mothers included
  • Mean age: 41.7 years
• 4,832 children included
  • Mean age: 11.4 years
• Duration of follow-up: Median was 11.4 years
• 14.3% women meant GDM criteria
• Over the course of the study, glucose metabolism disorder occurred more frequently in women with GDM
  • Mothers with GDM: 52.2%
  • Mothers without GDM: 20.1%
  • Odds ratio (OR) 3.44 (95% CI, 2.85 to 4.14)
  • Risk difference (RD) 25.7% (95% CI, 21.7% to 29.7%)
  • 10.7% had type 2 diabetes and 41.5% had prediabetes
• Children of mothers with GD
  • 39.5% were overweight or obese
  • 19.1% were obese
• Children of mothers without GD
  • 28.6% were overweight or obese
  • 9.9% were obese

Adjusted for maternal pregnancy BMI

• Children who are overweight or obese
  • OR 1.21 (95% CI, 1.00 to 1.46)
  • RD 3.7% (95% CI, −0.16% to 7.5%)
• Children who were obese
  • OR 1.58 (95% CI, 1.24 to 2.01)
  • RD 5.0% (95% CI, 2.0% to 8.0%)
• Body fat percentage
  • OR 1.35 (95% CI, 1.08 to 1.68)
  • RD 4.2% (95% CI, 0.9% to 7.4%)
• Waist circumference
  • OR 1.34 (95% CI, 1.08 to 1.67)
  • RD 4.1% (95% CI, 0.8% to 7.3%)
• Sum of skinfolds
  • OR 1.57 (95% CI, 1.27 to 1.95)
  • RD 6.5% (95% CI, 3.1% to 9.9%)

CONCLUSION:

• Gestational diabetes was associated with higher maternal risk for disorder of glucose metabolism
• GDM did not impact childhood risk for overweight or obese but did affect other parameters (e.g. obesity, body fat percentage, waist circumference and sum of skinfolds)
• The authors state

This study demonstrated that a larger population of women with lesser degrees of hyperglycemia (ie, IADPSG-defined gestational diabetes) were at risk for progression to prediabetes and type 2 diabetes

Learn More – Primary Sources:

Association of Gestational Diabetes With Maternal Disorders of Glucose Metabolism and Childhood Adiposity

Related ObG Topics:

Updated ACOG Guidance on Gestational Diabetes

ACOG and SMFM Both Release Guidance on Gestational Diabetes – Insulin vs Metformin for First-Line Therapy?

What Is The ‘One-Step’ GDM Screening Approach?

Screening for Gestational Diabetes: The ‘2 Step’ Approach