HAPO FUS shows persistent ill effects of maternal diabetes
medwireNews: The HAPO FUS investigators have reported that the increased risk for adiposity in the babies of women with gestational diabetes persists through to later childhood.
Furthermore, the women themselves had an elevated risk for dysglycemia and dyslipidemia around 11 years after their pregnancy.
And William Lowe (Northwestern University Feinberg School of Medicine) – one of four study investigators who presented the results at the American Diabetes Association scientific sessions in San Diego, California – said that the data just released represent the “tip of the iceberg.” The researchers obtained many more data from both mothers and children that will be addressed in future analyses, he said.
In particular, the team is keen to determine whether the combination of gestational diabetes plus obesity has an additive effect on later childhood and maternal outcomes, as it did on neonatal outcomes.
The findings of the original HAPO study, which involved 23,316 women and linked untreated gestational diabetes to neonatal adiposity, were used as the basis for the International Association of the Diabetes and Pregnancy Study Groups’ criteria for gestational diabetes, since adopted worldwide.
The follow-up study (HAPO FUS) involved 4697 mothers, aged an average of 41.7 years and including 14.3% who had experienced gestational diabetes, and their 4832 children, who were aged an average of 11.4 years.
Nearly a third (30.2%) of the children were overweight or obese according to the International Obesity Taskforce criteria, and 11.2% were obese. But the rates were higher if the children’s mothers had experienced gestational diabetes, at 39.5% versus 28.6% if they did not for overweight/obesity, and 19.1% versus 9.9% for obesity.
The results were similar for other measures of adiposity, including percentage body fat, waist circumference and the sum of skinfolds, and most associations persisted after accounting for variables including the children’s age, gender, and pubertal stage, multiple pregnancy variables, and maternal body mass index. Measures of adiposity at birth were also associated with adiposity in later childhood.
Gestational diabetes also affected the mothers’ longer-term outcomes, increasing their risk for dysglycemia. Specifically, diabetes was present in 10.7% of those who had experienced gestational diabetes versus 1.6% who had not, and the same was true of impaired fasting glucose, at 30.8% versus 9.7%, impaired glucose tolerance, at 28.7% versus 11.8%, and any of the three measures, at 52.2% versus 20.0%. In fact, there was a dose response, with the rates of dysglycemia by any measure rising from 16.1% for oral glucose tolerance test values of 74 mg/dL or less to 53.3% for 92 mg/dL or higher.
The likelihood of having hypertension at follow-up was not influenced by previous gestational diabetes, but dyslipidemia was, particularly levels of low-density lipoprotein cholesterol and triglycerides, with these persisting after accounting for multiple confounders.
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