Prevalence of metabolic markers of insulin resistance in offspring of gestational diabetes pregnancies.
In utero hyperglycemia has been associated with insulin resistance (IR) in children; however, there are limited data in low-risk populations. The purpose of this study was to describe the prevalence of metabolic markers of IR in a primarily Caucasian cohort of gestational diabetes mellitus (GDM) offspring aged 7-11 yr (mean 9.1) and to correlate offspring with maternal indexes. Sixty-eight children were recruited through a follow-up study of women who participated in a randomized controlled trial of minimal intervention vs. tight glycemic control for GDM. All participants had a fasting plasma glucose (FPG), insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-chol), triglyceride (TG) level, and a 2-h oral glucose tolerance test. We calculated homeostasis model assessment (HOMA) and recorded body mass index and waist circumference (WC). Criteria for metabolic syndrome for children included: FPG > 6.0 mmol/L, HDL-chol < 1.03 mmol/L, TG > 1.24 mmol/L, WC > 90% for age and gender, and 2-h glucose > 7.8 mmol/L. Among these children, 45 (66%), 17 (25%), 5 (7%), and 1 (1.5%) had zero, one, two, or three metabolic markers of IR, respectively. Hypertriglyceridemia (21%) was most prevalent, with no child having an elevated FPG. WC (p = 0.018) and TG (p = 0.005) were strong predictors of IR in the offspring after adjustment for age, gender, birthweight, family history, and maternal IR. Maternal and offspring HDL-chol, TG, WC, and HOMA but not fasting or 2-h glucose levels were significantly correlated. We conclude that metabolic markers of IR in children exposed to GDM may be present in the absence of abnormal fasting or 2-h glucose values. Screening strategies that focus on glucose levels may need to be reconsidered to institute early intervention with lifestyle changes for children at risk.
Keely
Erin J
EJ
Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Ontario, Canada. ekeely@ottawahospital.on.ca
Malcolm
Janine C
JC
Hadjiyannakis
Stasia
S
Gaboury
Isabelle
I
Lough
Gigi
G
Lawson
Margaret L
ML
D015992:Body Mass Index; D002648:Child; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology*; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007333:Insulin Resistance / Q000502:physiology*; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic