title: Exposure to Gestational Diabetes Mellitus: Impact on the Development of Early-Onset Type 2 Diabetes in Canadian First Nations and Non-First Nations Offspring.
abstract: Type 2 diabetes is increasing in children worldwide, with Canadian First Nations (FN) children disproportionally affected. The prevalence of gestational diabetes mellitus (GDM) also is increasing. The objective of this study was to evaluate the impact of GDM exposure in utero and FN status on the subsequent risk of type 2 diabetes in offspring in the first 30 years of life.
  
  
  
  In this population-based historical prospective cohort study, we used administrative databases linked to a clinical database to explore the independent association and interaction between GDM and FN status on the subsequent development of type 2 diabetes in offspring.
  
  
  
  Among 321,008 births with a median follow-up of 15.1 years, both maternal GDM and FN status were independently associated with subsequent risk of type 2 diabetes in offspring in the first 30 years of life (hazard ratio 3.03 [95% CI 2.44-3.76; P < 0.0001] vs. 4.86 [95% CI 4.08-5.79; P < 0.0001], respectively). No interaction between GDM and FN status on type 2 diabetes risk was observed. FN status had a stronger impact on the development of type 2 diabetes in offspring than GDM.
  
  
  
  GDM is an important modifiable risk factor for type 2 diabetes, and its prevention may reduce the prevalence of subsequent type 2 diabetes in offspring. This study adds unique and rigorous evidence to the global public health debate about the impact of GDM on the long-term health of offspring.
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada esellers@exchange.hsc.mb.ca.|Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Elizabeth A C
authors.initials: EA
authors.lastname: Sellers
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.|Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Dean
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Shafer
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Martens
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.|Assembly of Manitoba Chiefs, Winnipeg, Manitoba, Canada.
authors.forename: Wanda
authors.initials: W
authors.lastname: Phillips-Beck
authors.affiliation: Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.|Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.|Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Prior
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.|Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Allison B
authors.initials: AB
authors.lastname: Dart
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.|Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: McGavock
authors.affiliation: Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Morris
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Torshizi
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Sora
authors.initials: S
authors.lastname: Ludwig
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Garry X
authors.initials: GX
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002170:Canada / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000208:ethnology; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000208:ethnology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult