Gestational diabetes, but not pre-pregnancy overweight predicts cardio-metabolic markers in offspring twenty years later

• Published in: The Journal of Clinical Endocrinology & Metabolism
• Main Authors: Kaseva, Nina, Vääräsmäki, Marja, Sundvall, Jouko, Matinolli, Hanna-Maria, Sipola, Marika, Tikanmäki, Marjaana, Heinonen, Kati, Lano, Aulikki, Wehkalampi, Karoliina, Wolke, Dieter, Ruokonen, Aimo, Andersson, Sture, Järvelin, Marjo-Riitta, Räikkönen, Katri, Eriksson, Johan G., Kajantie, Eero
• Format: Article in Journal/Newspaper
• Language: unknown
• Published: The Endocrine Society 2019
• Subjects: RG Gynecology and obstetrics; Uusimaa; Northern Finland
• Online Access: http://wrap.warwick.ac.uk/114965/; http://wrap.warwick.ac.uk/114965/1/WRAP-Gestational-diabetes-pre-pregnancy-overweight-predicts-cardio-metabolic-Wolke-2019.pdf; http://wrap.warwick.ac.uk/114965/2/WRAP-supplementary_tables_1-4.pdf; http://wrap.warwick.ac.uk/114965/3/WRAP-figure_1_flow_chart_of_the_study_population.pptx; http://wrap.warwick.ac.uk/114965/4/WRAP-tables_1-3.pdf; https://doi.org/10.1210/jc.2018-02743

Context Maternal gestational diabetes (GDM) and pre-pregnancy overweight/obesity (body mass index, BMI ≥25kg/m2) may adversely affect offspring cardio-metabolic health. Objective To assess associations of maternal GDM and pre-pregnancy overweight/obesity with adult offspring cardio-metabolic risk factors. Design Longitudinal cohort study (ESTER and AYLS). Setting Province of Uusimaa and Northern Finland. Participants At mean age 24.1 years (SD 1.3), we classified offspring to offspring of mothers with 1) GDM regardless of pre-pregnancy BMI (OGDM; n=193), 2) normoglycemic mothers with pre-pregnancy overweight/obesity (ONO, n=157) and 3) normoglycemic mothers with pre-pregnancy BMI<25kg/m2 (controls, n=556). Main Outcome Measures We assessed cardio-metabolic biomarkers from blood and measured resting blood pressure and heart rate. Results Compared with controls, OGDM and ONO had higher fasting glucose [1.6% (95% confidence interval 0.1, 3.1)]; [2.3% (0.5, 4.3), respectively]; and insulin [12.7% (4.4, 21.9)]; [8.7% (0.2, 17.8)]. These differences attenuated to non-significance when adjusted for confounders and/or current offspring characteristics including BMI or body fat percentage. OGDM showed lower sex hormone binding globulin [SHBG; men: -12.4% (-20.2, -3.9), women: -33.2% (-46.3, -16.8)], high-density lipoprotein [-6.6% (-10.9, -2.2)] and apolipoprotein A1 [-4.5% (-7.5, -1.4), these differences survived the aforementioned adjustments. Heart rate and other biomarkers were similar between groups. Conclusions Adult offspring of mothers with GDM have increased markers of insulin resistance and a more atherogenic lipid profile; these are only partly explained by confounders or current offspring adiposity. Maternal pre-pregnancy overweight/obesity is associated with impaired offspring glucose regulation, which is explained by confounders and/or current adiposity.