Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1229-1234 (doi:10.1542/10.1542/peds.2008-0158)
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ARTICLE

Glucose Intolerance and Cardiometabolic Risk in Children Exposed to Maternal Gestational Diabetes Mellitus in Utero

Wing Hung Tam, MBChBa, Ronald Ching Wan Ma, MRCPb, Xilin Yang, PhDb, Gary Tin Choi Ko, MDc, Peter Chun Yip Tong, PhDb, Clive Stewart Cockram, MDb, Daljit Singh Sahota, PhDa, Michael Scott Rogers, MBChB, MDa and Juliana Chung Ngor Chan, MDb

a Departments of Obstetrics and Gynaecology
b Medicine and Therapeutics
c Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Hong Kong Special Administrative Region

OBJECTIVE. The goal was to examine the carbohydrate tolerance and cardiometabolic risk among children exposed to maternal gestational diabetes mellitus in utero.

METHODS. In this study, 164 Chinese children whose mothers had participated in a previous study on the screening and diagnosis of gestational diabetes mellitus (63 had gestational diabetes mellitus and 101 had normal glucose tolerance during the index pregnancies) underwent follow-up evaluations at a median age of 8 years (range: 7–10 years). Children's weight, height, hip and waist circumferences, and blood pressure were measured, and weight-adjusted oral glucose tolerance tests were performed.

RESULTS. Six children (3.7%) demonstrated impaired glucose regulation or diabetes mellitus at the follow-up evaluation. Children exposed to maternal gestational diabetes mellitus had significantly higher systolic (94 ± 1.2 vs 88 ± 0.9 mmHg) and diastolic (62 ± 0.8 vs 57 ± 0.6 mmHg) blood pressure values and lower high-density lipoprotein cholesterol (1.58 ± 0.04 vs 1.71 ± 0.03 mmol/L) levels, after adjustment for age and gender. A high (≥90th percentile) umbilical cord insulin level at birth was associated with abnormal glucose tolerance in the offspring.

CONCLUSIONS. Maternal gestational diabetes mellitus increases the offspring's cardiometabolic risk, and in utero hyperinsulinemia is an independent predictor of abnormal glucose tolerance in childhood.

Key Words: gestational diabetes • children • blood pressure • cholesterol

Abbreviations: DM—diabetes mellitus • BP—blood pressure • OGTT—oral glucose tolerance test • NGT—normal glucose tolerance • PG—plasma glucose • GDM—gestational diabetes mellitus • IGR—impaired glucose regulation • AGT—abnormal glucose tolerance • HDL-C—high-density lipoprotein cholesterol • IGT—impaired glucose tolerance

Accepted Mar 12, 2008.


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