title: Intrauterine exposure to gestational diabetes, child adiposity, and blood pressure.
abstract: BACKGROUND
  Intrauterine exposure to gestational diabetes mellitus (GDM) may promote offspring obesity and higher systolic blood pressure (SBP) by adolescence. Few studies have examined adiposity or SBP in younger children exposed to GDM. This study's objective was to examine associations of maternal glucose tolerance during pregnancy with offspring adiposity and SBP at age 3 years.
  
  
  METHODS
  We studied 1,238 mother-child pairs in Project Viva, a prospective prebirth cohort study. Exposures were maternal blood glucose following oral glucose load, and GDM confirmed by 3-h glucose tolerance test. Main child outcomes were age 3-year body mass index (BMI) z-score, the sum (SS+TR) and ratio (SS/TR) of subscapular (SS) and tricep (TR) skinfold thicknesses, and SBP. We performed adjusted multivariable analyses.
  
  
  RESULTS
  Fifty-one (4%) mothers had GDM. 9.3% of 3 year-old children were obese and mean (s.d.) SBP was 92 (11) mm Hg. Children exposed to GDM had higher SBP (3.2 mm Hg, 95% confidence interval (CI): 0.4, 5.9, P = 0.02) and greater adiposity when assessed by the sum of skinfolds (SS+TR 1.31 mm, 95% CI: 0.08, 2.55, P = 0.04) but not by BMI z-score (-0.08 units, 95% CI: -0.37, 0.22, P = 0.61). After additional adjustment for the sum of skinfold thicknesses (SS+TR), the relationship between GDM and SBP was attenuated and no longer significant (2.6 mm Hg, 95% CI: -0.2, 5.4, P = 0.07).
  
  
  CONCLUSIONS
  Children exposed to GDM have higher adiposity, which may mediate the higher SBP in these children. These findings extend to younger children the adverse effects of GDM previously found among adolescents and adults.
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. smich@mail.med.upenn.edu
authors.forename: Charmaine S
authors.initials: CS
authors.lastname: Wright
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D002675:Child, Preschool; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D009765:Obesity / Q000209:etiology / Q000503:physiopathology; D011247:Pregnancy / Q000097:blood; D011297:Prenatal Exposure Delayed Effects / Q000503:physiopathology
chemical_list: D001786:Blood Glucose