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

作者：Lowe, William L., Jr.; Scholtens, Denise M.; Lowe, Lynn P.; Kuang, Alan; Nodzenski, Michael; Talbot, Octavious; Catalano, Patrick M.; Linder, Barbara; Brickman, Wendy J.; Clayton, Peter; Deerochanawong, Chaicharn; Hamilton, Jill; Josefson, Jami L.; Lashley, Michele; Lawrence, Jean M.; Lebenthal, Yael; Ma, Ronald; Maresh, Michael; McCance, David; Tam, Wing Hung; Sacks, David A.; Dyer, Alan R.; Metzger, Boyd E.^*

来源：JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2018, 320(10): 1005-1016.

DOI：10.1001/jama.2018.11628

• BODY-MASS INDEX
• PREGNANCY
• MELLITUS
• HYPERGLYCEMIA
• OBESITY
• WOMEN
• RISK
• CLASSIFICATION
• PREDICTORS
• CRITERIA

IMPORTANCE The sequelae of gestational diabetes (GD) by contemporary criteria that diagnose approximately twice as many women as previously used criteria are unclear. @@@ OBJECTIVE To examine associations of GD with maternal glucose metabolism and childhood adiposity 10 to 14 years' postpartum. @@@ DESIGN, SETTING, AND PARTICIPANTS The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study established associations of glucose levels during pregnancy with perinatal outcomes and the follow-up study evaluated the long-term outcomes (4697 mothers and 4832 children; study visits occurred between February 13, 2013, and December 13, 2016). @@@ EXPOSURES Gestational diabetes was defined post hoc using criteria from the International Association of Diabetes and Pregnancy Study Groups consisting of 1 or more of the following 75-g oral glucose tolerance test results (fasting plasma glucose >= 92mg/dL; 1-hour plasma glucose level >= 180mg/dL; 2-hour plasma glucose level >= 153mg/dL). @@@ MAIN OUTCOMES AND MEASURES Primary maternal outcome: a disorder of glucose metabolism (composite of type 2 diabetes or prediabetes). Primary outcome for children: being overweight or obese; secondary outcomes: obesity, body fat percentage, waist circumference, and sum of skinfolds (>85th percentile for latter 3 outcomes). @@@ RESULTS The analytic cohort included 4697 mothers (mean [SD] age, 41.7 [5.7] years) and 4832 children (mean [SD] age, 11.4 [1.2] years; 51.0% male). The median duration of follow-up was 11.4 years. The criteria for GD were met by 14.3%(672/4697) of mothers overall and by 14.1%(683/4832) of mothers of participating children. Among mothers with GD, 52.2% (346/663) developed a disorder of glucose metabolism vs 20.1%(791/3946) of mothers without GD (odds ratio [OR], 3.44 [95% CI, 2.85 to 4.14]; risk difference [RD], 25.7%[95% CI, 21.7% to 29.7%]). Among children of mothers with GD, 39.5%(269/681) were overweight or obese and 19.1%(130/681) were obese vs 28.6%(1172/4094) and 9.9% (405/4094), respectively, for children of mothers without GD. Adjusted for maternal body mass index during pregnancy, the OR was 1.21 (95% CI, 1.00 to 1.46) for children who were overweight or obese and the RD was 3.7%(95% CI, -0.16% to 7.5%); the OR was 1.58 (95% CI, 1.24 to 2.01) for children who were obese and the RD was 5.0%(95% CI, 2.0% to 8.0%); the OR was 1.35 (95% CI, 1.08 to 1.68) for body fat percentage and the RD was 4.2%(95% CI, 0.9% to 7.4%); the OR was 1.34 (95% CI, 1.08 to 1.67) for waist circumference and the RD was 4.1%(95% CI, 0.8% to 7.3%); and the OR was 1.57 (95% CI, 1.27 to 1.95) for sum of skinfolds and the RD was 6.5%(95% CI, 3.1% to 9.9%). @@@ CONCLUSIONS AND RELEVANCE Among women with GD identified by contemporary criteria compared with those without it, GD was significantly associated with a higher maternal risk for a disorder of glucose metabolism during long-term follow-up after pregnancy. Among children of mothers with GD vs those without it, the difference in childhood overweight or obesity defined by body mass index cutoffs was not statistically significant; however, additional measures of childhood adiposity may be relevant in interpreting the study findings.

• 出版日期2018-9-11
• 单位西北大学