Monogenic and Type 2 Diabetes, Obesity O/THU/1/01 Maternal obesity is the strongest predictor of overweight in offspring of women with gestational diabetes mellitus

Objectives: Offspring of women with gestational diabetes mellitus (GDM) are at increased risk for obesity and diabetes mellitus in later life. Fetal imprinting by intrauterine diabetic environment and early postnatal determinants affects the development of these chronic diseases in addition to socio-economic and genetic determinants. The purpose of this study was to identify the strongest predictor of childhood obesity in offspring of women with GDM and to evaluate the development of insulin resistance depending on Body Mass Index (BMI). Methods: Offspring of women with GDM (n = 331) were recruited since September 1989 for our German GDM prospective study. Venous blood sampling and collection of questionnaire data of mother and child were performed at birth as well as at ages 9 months, 2, 5, 8, 11 and 14 years. Following determinants were analysed: maternal obesity before pregnancy, insulin treatment during pregnancy, LGA status, exclusive breastfeeding 3 months, smoking behaviour during pregnancy. Furthermore, we analysed the influence of overweight on the development of insulin resistance. Results: Determinants of overweight in early childhood (age 2 years) were LGA status (OR = 5.23; P = 0.000), insulin treatment during pregnancy (OR = 2.39; P = 0.018) and maternal obesity (OR = 3.53; P = 0.017). Overweight in early adolescence (age 8 and 11 years) was decisively influenced by maternal obesity (OR = 12.0; P = 0.012 and OR = 7.58; P = 0.021), whilst LGA status had decreasing to no significant influence at age 8 and 11 years (OR = 3.25; P = 0.049 and OR = 3.47; P = 0.063) and insulin treatment during pregnancy was no longer significant. Multivariate analysis confirmed maternal obesity and LGA status as independent determinants of risk at age 8 years (P = 0.027 and P = 0.037). Exclusive breastfeeding 3 months and smoking behaviour during pregnancy did not significantly affect risk for obesity in offspring of women with GDM. Insulin sensitivity was significantly reduced in overweight children in comparison to normal weight children (HOMA-IR, median: 1.82; IQR: 1.31–2.60 vs. median: 0.94; IQR: 0.62–1.35; P = 0.000). Conclusions: The following determinants influenced the development of overweight in early childhood: LGA status, insulin treatment during pregnancy and maternal obesity. In early adolescence maternal obesity is the strongest predictor of overweight in children of women with GDM. Overweight in childhood and early adolescence correlated highly significant with insulin resistance.