Gestational diabetes : long-term, metabolic consequences for the mother and child
1University of Oulu, Faculty of Medicine, Institute of Clinical Medicine, Department of Obstetrics and Gynecology
2University of Oulu, Faculty of Medicine, Institute of Clinical Medicine, Department of Paediatrics
3National Institute for Health and Welfare, Department of Child and Adolescent Health an Welfare Unit
|Online Access:||PDF Full Text (PDF, 0.8 MB)|
|Persistent link:|| http://urn.fi/urn:isbn:9789514261701
|Publish Date:|| 2010-06-01
|Thesis type:||Doctoral Dissertation
|Defence Note:||Academic dissertation to be presented with the assent of the Faculty of Medicine of the University of Oulu for public defence in Auditorium 4 of Oulu University Hospital, on 11 June 2010, at 12 noon
Professor Risto Kaaja
Docent Eero Kajantie
Gestational diabetes (GDM) indicates increased risk for diabetes and the metabolic syndrome in women. Research on prenatal exposure to GDM as a risk factor for metabolic diseases is conflicting. Overweight (body mass index ≥ 25 kg/m2) is a strong risk factor for GDM and metabolic diseases; however, there are few published previous studies distinguishing the separate effects of overweight and GDM on the later risk for metabolic diseases in women and their children.
The present study evaluated pre-pregnancy overweight and GDM as determinants of long-term risk for diabetes and hypertension in women, and the metabolic consequences of prenatal exposures to maternal pre-pregnancy overweight and different types of maternal diabetes in children. The results are based on prospective, clinical data from Oulu University Hospital (n = 63 mothers and their children), and the Northern Finland Birth Cohort 1986 (NFBC 1986, n = 9,362 mothers and their 9,479 children).
Compared to normal-weight mothers with normal glucose tolerance in pregnancy, the NFBC 1986 mothers with simultaneous pre-pregnancy overweight and GDM had strikingly high risks for developing diabetes (hazard ratio, HR 47.2; 95% confidence interval 25.5–87.4) and hypertension (HR 9.2 [6.1–13.9]) twenty years after delivery. The risks for these diseases were elevated in mothers with pre-pregnancy overweight even when they had normal glucose tolerance during pregnancy (HR diabetes 12.6 [7.4–21.6], HR hypertension 2.9 [2.1–3.9]). GDM per se indicated increased risk only for diabetes (HR 10.6 [4.2–27.0]).
In the cohort from Oulu University Hospital, increased fasting insulin concentration (P = 0.04), first phase insulin response (P = 0.03), and HOMA-B (P = 0.008) were already observed at pre-school age in the offspring of mothers with Type 1 diabetes compared with offspring of mothers with GDM.
In the NFBC 1986 offspring, the prevalence of metabolic syndrome was 2.4% at age 16 years, using the International Diabetes Federation pediatric definition. Abdominal obesity, a waist girth over half one’s length, defined approximately 85% of the adolescents with metabolic syndrome. The risks for overweight and abdominal obesity were high in those with prenatal exposure to both maternal pre-pregnancy overweight and GDM (odds ratio for overweight 4.1 [1.9–8.6], for abdominal obesity 3.8 [1.7–8.8]). In children of normal-weight women, prenatal exposure to GDM was not associated with increased risk of these outcomes.
Based on this study, preventing and reducing overweight in fertile age seems to be a key target for preventing metabolic diseases in women and their children.
Acta Universitatis Ouluensis. D, Medica
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