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Gestational diabetes may increase child’s risk of glucose intolerance

Publish date: September 4, 2014
By
Tara Haelle

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Increased risk of GDM points to opportunity for patient education

The study by Holder et al. confirms previous findings that a child’s exposure to maternal GDM can predispose him or her to developing impaired glucose tolerance or type 2 diabetes later in life. Seminal work by David Pettitt and Peter Bennett, who studied the Pima Indians in Arizona, showed that a child born to a mother without GDM and a child born to the same mother with GDM had different susceptibilities to developing metabolic disease. They found that the child exposed to GDM had a higher likelihood of developing diabetes.

The findings of Holder et al. reinforce the idea that maternal health can greatly influence the long-term health of her offspring. It is conceivable that diabetes may "imprint" information onto the islet cells of the developing fetus, thereby resulting in the reduced beta-cell function and reduced insulin sensitivity observed by the investigators. Although it remains to be elucidated, it is not unlikely that there are diabetes susceptibility genes, which women may pass on to their offspring. If so, this could explain why only some children of GDM mothers develop impaired glucose tolerance or type 2 diabetes mellitus while others do not.


E. Albert Reece

Counseling children of diabetic mothers on the importance of a healthy lifestyle, maintaining an ideal weight, consuming a balanced diet, and getting enough physical exercise could reduce their risk of future metabolic disease. Because the exposure to maternal hyperglycemia cannot be reversed, it is vital that children of GDM mothers take steps needed to reduce their risks of developing diabetes.

Dr. E. Albert Reece, M.D., Ph.D., M.B.A., is the Vice President for Medical Affairs at the University of Maryland, Dean of the School of Medicine, and the John Z. and Akiko K. Bowers Distinguished Professor in Obstetrics and Gynecology. He made these comments in an interview. Dr. Reece had no relevant financial disclosures.


 

FROM DIABETOLOGIA

References

Obese children may have a higher risk of developing type 2 diabetes if their mothers had gestational diabetes during pregnancy, according to a recent study.

"The ever growing number of women with gestational diabetes (18%) suggests that the future will be filled with children with early diabetes at a rate that far exceeds the current prevalence," wrote Tara Holder of Yale University, New Haven, Conn., and her associates in Diabetologia.

"Offspring of GDM [gestational diabetes mellitus] mothers ought to be screened for impaired glucose tolerance and/or impaired fasting glucose, and preventive and therapeutic strategies should be considered before the development of full clinical manifestation of diabetes," the researchers reported online (Diabetologia 2014 Aug. 29 [doi: 10.1007/s00125-014-3345-2]).

The investigators conducted an oral glucose tolerance test to establish normal glucose tolerance among 210 obese teens who had not been exposed to GDM and 45 obese teens who had been exposed. Then they conducted another OGTT at an average follow-up of 2.8 years later.

A fasting glucose level of less than 5.55 mmol/L and a 2-hour glucose level of less than 7.77 mmol/L were defined as normal glucose tolerance. A fasting glucose of 5.55-6.88 mmol/L was considered impaired, and a fasting glucose greater than 6.88 mmol/ L or a 2-hour glucose greater than 11.05 mmol/L was designated type 2 diabetes.

At follow-up, 91.4% of the teens not exposed to GDM had normal glucose tolerance, compared with 68.9% of the teens exposed to GDM. Therefore, 8.6% of those not exposed to GDM and 31.1% of those exposed to GDM had developed either impaired glucose tolerance or type 2 diabetes.

The research and researchers were supported by the National Center for Advancing Translational Science, the Yale Diabetes Endocrinology Research Center, the European Society of Pediatric Endocrinology, the American Heart Association, the Stephen Morse Diabetes Research Foundation, the National Institutes of Health, and the American Diabetes Association. The authors had no disclosures.

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