Mean (s.d.) maternal age was 32.5 (5.0) years, and prepregnancy BMI 24.6 (5.1) kg/m2. Mothers’ race/ethnicity was 73% white, 12% black, 6% Hispanic, and 9% other; 71% were college graduates, and 65% had total household income of $70,000/year or more.
We identified 51 (4%) mothers with GDM, and an additional 152 (12%) with IGT. When compared to normoglycemic mothers, those with IGT or GDM were older and had higher prepregnancy BMI and pregnancy weight gain (). Mothers with GDM were slightly less likely to be white and were more likely to have maternal family history of DM or GDM. Among the 25 Project Viva mothers with GDM who had a recorded hemoglobin A1C value during pregnancy, mean (s.d.) was 5.3 (0.6)%, reflecting excellent control.
Characteristics of 1,238 mother-child pairs in Project Viva, according to maternal glycemia during pregnancy
Three-year-old children had a mean (s.d.) BMI z
-score of 0.45 (1.0) units, 17.1% were overweight (BMI >85–95th percentile), and 9.3% were obese (BMI >95th percentile), slightly lower than the contemporaneous national average of 13.9% for children aged 2–5 years.24,25
Mean child SBP was 92 (11) mm Hg, similar to the median for US children in the 50th percentile for height at age 3 years (male 91 mm Hg, female 89 mm Hg).26
In unadjusted analyses, compared with offspring of normoglycemic mothers, infants born to mothers with IGT had greater fetal growth, but offspring of mothers with GDM were not larger at birth (). At age 3 years, offspring of diabetic mothers had higher mean SBP than offspring of normoglycemic mothers.
Child characteristics among 1,238 mother-child pairs in Project Viva, according to maternal glycemia during pregnancy
In analyses adjusted only for child sex and age, GDM was not associated with offspring BMI z-score at age 3 years (0.02 units, 95% confidence interval (CI) −0.27, 0.32, P = 0.87). However, when overall adiposity was assessed by the sum of the skinfolds, maternal GDM was associated with somewhat greater SS+TR (0.92 mm, 95% CI −0.27, 2.11, P = 0.13). After adjustment for maternal age, education, race/ethnicity, smoking history, BMI, pregnancy weight gain, parity, paternal BMI, and fetal growth, maternal GDM was more strongly associated with child SS+TR (1.31 mm, 95% CI 0.08, 2.55, P = 0.04) but still not associated with BMI z-score (−0.08 units, 95% CI −0.37, 0.22, P = 0.61). Maternal IGT was not associated with offspring SS+TR (0.25 mm, 95% CI −0.48, 0.99, P = 0.5) () or BMI z-score (0.002 units, 95% CI −0.17, 0.17, P = 0.98). Maternal GDM was not associated with offspring central adiposity, measured as SS/TR ratio (0.01, 95% CI −0.04, 0.05, P = 0.8). However, IGT was marginally associated with higher SS/TR (0.03, 95% CI 0.001, 0.06, P = 0.05).
Associations of intrauterine exposure to IGT and GDM with child overall and central adiposity at age 3 years
In analyses adjusted for sex, age, and measurement conditions, children exposed to GDM in utero had SBP 3.2 (95% CI 0.6, 5.7, P = 0.02) mm Hg higher than children born to normoglycemic mothers (). Further adjustment for maternal education, race/ethnicity, age, smoking, paternal BMI and hypertension, maternal prepregnancy BMI, postpartum SBP, parity, and pregnancy weight gain did not substantially change the association (3.0 mm Hg 95% CI 0.2, 5.8, P = 0.03). Further adjustment for fetal growth, attained child BMI z-score, and height—measures that might be in the pathway between intrauterine exposure and child blood pressure—did not attenuate results (3.2 mm Hg, 95% CI 0.4, 5.9, P = 0.02). However, final adjustment for sum of skin-folds (SS+TR) did attenuate estimates and significance (2.6 mm Hg, 95% CI: −0.2, 5.4, P = 0.07) (). We did not observe any association of maternal IGT with offspring SBP (−0.7 mm Hg, 95% CI: −2.4, 0.9, P = 0.39) with additional adjustment for SS+TR.
Associations of intrauterine exposure to IGT and GDM with child SBP at age 3 years
Figure 1 Associations of intrauterine exposure to gestational diabetes mellitus with body mass index (BMI) z-score, sum of subscapular and triceps skinfolds (SS+TR), and systolic blood pressure (SBP) at age 3 years, among 1,238 mother-child pairs in Project Viva. (more ...)
For each increase of 10 mg/dl in maternal blood glucose following glucose challenge testing, we observed no effect on offspring BMI z-score (−0.01 units, 95% CI: −0.03, 0.01, P = 0.5), SS/TR (0.003, 95% CI: −0.001, 0.006, P = 0.13), SS+TR (0.03 mm, 95% CI: −0.07, 0.12, P = 0.6) or SBP (0.02 mm Hg, 95% CI: −0.19, 0.23, P = 0.88) in fully adjusted models.