Gestational diabetes has minimal impact on childhood obesity risk
medwireNews: Maternal BMI prior to and during early pregnancy has a greater impact than gestational diabetes and hypertension, and pre-eclampsia on the risk for increased BMI in childhood, study findings indicate.
“Therefore, although lowering maternal risk of gestational diabetes, gestational hypertension, and pre-eclampsia is important in relation to maternal and fetal pregnancy outcomes, such intervention is unlikely to have a direct impact on obesity in offspring among women receiving contemporary medical care in developed countries,” say Romy Gaillard (University Medical Center, Rotterdam, the Netherlands) and co-authors from the MOCO Study Group.
They suggest: “Preventive strategies for reducing childhood obesity should focus on maternal BMI rather than on pregnancy complications.”
The conclusions are based on an individual participant data meta-analysis of 160,757 mother–offspring pairs from 34 prospective European and North American cohorts.
Overall, 1.7% of the mothers had gestational diabetes, 6.5% had gestational hypertension, and 3.3% had pre-eclampsia, while 19.7% were overweight and 7.9% were obese.
The researchers report in The Lancet Child and Adolescent Health that, compared with children of uncomplicated pregnancies, those whose mothers had gestational diabetes were significantly more likely to be overweight or obese throughout childhood, at odds ratios (ORs) of 1.59 during early childhood (age 2.0–4.9 years), 1.41 during mid childhood (5.0–9.9 years), and 1.32 during late childhood (10.0–17.9 years), after adjustment for sex, maternal age, educational level, ethnicity, parity, and smoking during pregnancy.
However, when maternal BMI was also taken into account the associations were attenuated to ORs of 1.35 and 1.12 for early and mid childhood, respectively, and were no longer significant for late childhood.
Similarly, gestational hypertension was associated with a significantly increased likelihood for being overweight during early, mid, and late childhood, at ORs of 1.19, 1.23, and 1.49, respectively, but the associations were again attenuated upon additional adjustment for maternal BMI, with late childhood the only significant association remaining (OR=1.18).
By contrast, pre-eclampsia was associated with significantly decreased BMI in early childhood, but a significantly increased BMI during mid and late childhood. Additional adjustment for maternal BMI strengthened the early childhood relationship but attenuated that for mid and late childhood.
In an accompanying commentary, Anna-Maria Siega-Riz describes the findings as unsurprising because “obese women enter pregnancy with an already altered metabolic profile and might have unhealthy dietary habits and insufficient physical activity.”
Therefore, “[t]he study highlights the importance of women entering pregnancy at a more optimal weight status,” she writes.
Siega-Riz notes that it is currently unknown “whether appropriate dietary habits and levels of physical activity during pregnancy could mitigate the effects of intrauterine programming by the obese metabolic profile” but she suggests that “[t]he pre-conception or inter-pregnancy period might be the most feasible time to alter lifestyle behaviours that affect weight status and future cardiometabolic risk to the mother and her child.”
By Laura Cowen
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