title: Intensive gestational glycemic management and childhood obesity: a systematic review and meta-analysis.
abstract: Hyperglycemia in pregnancy is associated with increased risk of offspring childhood obesity. Treatment reduces macrosomia; however, it is unclear if this effect translates into a reduced risk of childhood obesity. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of intensive glycemic management in pregnancy in preventing childhood obesity.
  
  
  
  We searched MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov up to February 2016 and conference abstracts from 2010 to 2015. Two reviewers independently identified randomized controlled trials evaluating intensive glycemic management interventions for hyperglycemia in pregnancy and included four of the 383 citations initially identified. Two reviewers independently extracted study data and evaluated internal validity of the studies using the Cochrane Collaboration's Risk of Bias tool. Data were pooled using random-effects models. Statistical heterogeneity was quantified using the I2test. The primary outcome was age- and sex-adjusted childhood obesity. Secondary outcomes included childhood weight and waist circumference and maternal hypoglycemia during the trial (safety outcome).
  
  
  
  The four eligible trials (n=767 children) similarly used lifestyle and insulin to manage gestational hyperglycemia, but only two measured offspring obesity and waist circumference and could be pooled for these outcomes. We found no association between intensive gestational glucose management and childhood obesity at 7-10 years of age (relative risk 0.89, 95% confidence interval (CI) 0.65 to 1.22; two trials; n=568 children). Waist circumference also did not differ between treatment and control arms (mean difference, -2.68 cm; 95% CI, -8.17 to 2.81 cm; two trials; n=568 children).
  
  
  
  Intensive gestational glycemic management is not associated with reduced childhood obesity in offspring, but randomized data is scarce. Long-term follow-up of trials should be prioritized and comprehensive measures of childhood metabolic risk should be considered as outcomes in future trials.
authors.affiliation: Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Guillemette
authors.affiliation: Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Durksen
authors.affiliation: George &Fay Yee Center for Healthcare Innovation, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Rabbani
authors.affiliation: George &Fay Yee Center for Healthcare Innovation, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Zarychanski
authors.affiliation: George &Fay Yee Center for Healthcare Innovation, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Abou-Setta
authors.affiliation: Health, Leisure &Human Performance Research Institute, University of Manitoba, and Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada.
authors.forename: T A
authors.initials: TA
authors.lastname: Duhamel
authors.affiliation: Children's Hospital Research Institute of Manitoba, and Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: McGavock
authors.affiliation: Children's Hospital Research Institute of Manitoba, and Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Wicklow
mesh_terms: D002648:Child; D016640:Diabetes, Gestational / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D005320:Fetal Macrosomia; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D063766:Pediatric Obesity / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control* / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin