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.
Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Ontario, Canada. ekeely@ottawahospital.on.ca
Erin J
EJ
Keely
Janine C
JC
Malcolm
Stasia
S
Hadjiyannakis
Isabelle
I
Gaboury
Gigi
G
Lough
Margaret L
ML
Lawson
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