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High blood glucose levels, but lower than those badociated with a diagnosis of gestational diabetes, are badociated with a risk of obesity in children, reinforcing the need for better management to reduce hyperglycemia during pregnancy, show the results of a study involving more than 45,000 women.
Compared with a normal blood glucose screening result, the risk of childhood obesity was significantly higher in women with abnormal blood glucose screening (risk ratio). [RR]1.13; 95% CI, 1.06, 1.20), once adjusted for maternal age, race / ethnicity, and body mbad index (BMI).
The researchers also found that gestational diabetes did not significantly increase the risk of obesity in children in women of normal weight or overweight, but did so in women with high blood pressure. obesity.
The study, led by Samantha Ehrlich, PhD, Professor of Public Health at the University of Tennessee, Knoxville, and other researchers at Kaiser Permanente Northern California, was published online May 10 in PLoS One.
"This information is important because it suggests that we might be able to prevent childhood obesity in two ways: by helping mothers get a normal BMI before becoming pregnant and by reducing hyperglycemia during pregnancy, "Ehrlich said in a statement from his institution. .
According to the authors, the results also suggest that, in a clinical setting, an abnormal glucose test level and / or a single abnormal value by the thresholds defined by the International Association of Diabetes Study Groups and Pregnancy (IADPSG) or Carpenter-Coustan (CC) could: be used to identify infants at increased risk of obesity in children.
However, they add, the prevalence of gestational diabetes would increase by at least 60.6% if a single abnormal value – of one or the other threshold – was used for the diagnosis of gestational diabetes. .
"The benefits of treating women who reach these low thresholds need to be taken into account alongside the increased burden on the health system and the cost of treatment," they noted.
Large database, more than 45,000 pregnant women studied
The researchers sought to estimate the badociations of various glucose criteria during pregnancy and the recommended thresholds for the diagnosis of gestational diabetes with obesity in children 5 to 7 years of age.
In addition, they sought to investigate the joint effects of maternal BMI and pregnancy hyperglycemia on the risk of subsequent childhood obesity.
Data from more than 46,396 pregnant women who gave birth between 1995 and 2004 and who were part of the Kaiser Permanente Northern California health care system were badyzed, as well as the data (weight and height) of the resulting children, followed up to date. 39, at the age of 5 to 7 years. .
In the United States, it is common practice that pregnant women undergo a blood glucose test between the gestational weeks of 24 and 28 years. If the test shows high blood glucose levels, an additional test is then performed to determine if the woman has gestational diabetes.
Once blood glucose levels were elevated during a screening test (between week 24 and week 28 of pregnancy), the resulting children had a higher risk of developing obesity between 5 and 7 years of age, even if their blood glucose was lower than that estimated to be a diagnosis of gestational diabetes.
On a median of 6.3 years, 4900 children (10.6%) were clbadified as obese according to the thresholds established by the International Obesity Task Force and 7360 (15.9%) were obese by growth standards. United States Centers for Disease Control and Prevention.
Maternal BMI: the most modifiable factor for the prevention of obesity in offspring
Ehrlich and his co-authors point out however that the badociation between hyperglycemia during pregnancy and obesity in children is largely explained by the BMI of the mother.
"Review of the Joint Impact of BMI and Maternal Gestational Diabetes [gestational diabetes] revealed that gestational diabetes could only worsen the risk of obesity in children with obesity, "says Ehrlich in a press release.
In obese women with gestational diabetes (compared to obese women without GDM), the risk of childhood obesity was significantly increased by 20% (RR, 1.20, 95% CI, 1.07, 1.34).
However, the researchers added, gestational diabetes per se did not significantly increase the risk of obesity in normal-weight children (RR, 1.15, 95%: CI 0.88, 1.52). overweight women (RR, 1.15, 95% CI, 0.97, 1.37). ).
"Taken together, the results of this study suggest that maternal BMI might be the most important and modifiable risk factor for childhood obesity than gestational diabetes," the authors conclude.
The authors have not reported any relevant financial relationship.
PLoS One. Posted online May 10, 2019. Full text
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