During pregnancy, across the maternal glucose spectrum, higher glucose levels are significantly linked to childhood glucose and insulin resistance in offspring regardless of family history of diabetes and maternal and childhood body mass index (BMI), according to a study published in Diabetes Care.
In a follow-up study, an international team of researchers analyzed maternal glycemia during pregnancy and childhood glucose outcomes from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, an observational, population-based international study that identified a link between maternal glucose and adverse perinatal outcomes.
The investigators invited 4832 children aged 10 to 14 years whose mothers had a 75-g oral glucose tolerate test at or near 28 weeks’ gestation to participate in the study; 4160 children were evaluated for glucose outcomes.
Primary outcomes were impaired glucose tolerance and impaired fasting glucose among children. Secondary outcomes included glucose-related measures using plasma glucose, glycated hemoglobin (HbA1c), and C-peptide from child oral glucose tolerance tests to determine insulin sensitivity. The disposition index, which is a measure of pancreatic β-cell function, was also calculated.
Maternal fasting plasma glucose measurements were positively associated with fasting plasma glucose and HbA1c levels in children; 1-hour and 2-hour maternal plasma glucose levels were linked to 30-minute, 1-hour, and 2-hour plasma glucose and HbA1c levels in children. Maternal fasting plasma glucose and 1-hour and 2-hour plasma glucose levels were inversely related to insulin sensitivity. Additionally, 1-hour and 2-hour plasma glucose measurements were inversely related to the disposition index. Maternal fasting glucose levels were associated with child impaired fasting glucose levels, and 1-hour and 2-hour plasma glucose levels were associated with impaired glucose tolerance.
These associations were independent of maternal and child BMI. The authors noted that across increasing categories of maternal glucose, insulin sensitivity and the disposition index decreased, while timed plasma glucose, child impaired fasting glucose levels and impaired glucose tolerance, and HbA1c measurements increased.
“The current study demonstrates that maternal glucose levels during pregnancy across the spectrum are associated with higher glucose levels and insulin resistance during childhood, independent of maternal and child BMI and family history of diabetes, and that this relationship is continuous,” the authors wrote. “Although the underlying causes for the increasing prevalence of type 2 diabetes in children are complex, these findings suggest that maternal glycemia may also contribute.”
Scholtens DM, Kuang A, Lowe LP, et al; for the HAPO Follow-Up Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome follow-up study (HAPO FUS): maternal glycemia and childhood glucose metabolism [published online January 7, 2019]. Diabetes Care. doi:10.2337/dc18-2021