Long-term effects of diabetes during pregnancy on the offspring.

BACKGROUND: Many epidemiological and experimental studies have proven that some adult diseases might have their origin in fetal life. It has been also hypothesized that intra-uterine environment in pregnancy complicated with diabetes might influence the development of obesity, type 2 diabetes, and cardiovascular diseases in the offspring.

OBJECTIVES: To assess glucose metabolism, insulin secretion, and prevalence of obesity in the offspring of mothers with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) and to evaluate the relationship between maternal metabolic control during pregnancy and metabolic disturbances in children.

SUBJECTS: Children of mothers with PGDM (n = 43) and GDM (n = 34) were examined at 4-9 yr of age and compared with the control group (n = 108; metabolic parameters available for n = 29).

METHODS: The incidence of overweight and obesity, impaired glucose tolerance, and insulin resistance were analyzed based on anthropometric and biochemical measurements. Statistical analysis was performed with statistica package.

RESULTS: In children of GDM mothers, body mass index z-score (0.81 +/- 1.01 vs. -0.04 +/- 1.42 PGDM vs. 0.07 +/- 1.28 control group) and insulin resistance indices (homeostasis model assessment index - insulin resistance 1.112 vs. 0.943 PGDM vs. 0.749 control group) were significantly higher than in other groups. Obesity and insulin resistance were also most frequent in GDM group [not significant (NS)]. In addition, we observed the relationship between maternal hemoglobin A1c and mean glycemia in perinatal period and insulin resistance in children. There was not such correlation for the class of maternal diabetes.

CONCLUSION: Children born to mothers with gestational diabetes seem to be at risk for obesity and metabolic disturbances.