Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
Int J Epidemiol. 2017 Oct 1;46(5):1533-1541. doi: 10.1093/ije/dyx151.
Animal data suggest sexually dimorphic programming of obesity in response to altered intrauterine environment, but the longitudinal impact of gestational diabetes mellitus (GDM) on sex-specific risk of offspring obesity in humans is unclear.
We conducted a prospective analysis of 15 009 US individuals (7946 female and 7063 male) from the Growing-Up Today Study, who were followed from 1996 (ages 9-14 years) through 2010. Height and weight from validated questionnaires were used to derive body mass index (BMI) at different ages. Obesity during childhood (< 18 years) and adulthood (≥ 18 years) were defined using the International Obesity Task Force and the World Health Organization criteria. GDM exposure was identified through self-reported questionnaires from mothers. Relative risks were estimated using multivariable log-binomial regression models with generalized estimating equations accounting for clustering within the same family.
Male offspring born from pregnancies complicated by GDM had higher BMI compared with non-GDM offspring and had increased risk of obesity; the adjusted relative risk [RR, 95% confidence interval (CI)] was 1.47 (1.11-1.95) for all age groups, 1.59 (1.05-2.41) for late childhood, 1.48 (1.06-2.06) for adolescence and 1.39 (1.00-1.94) for early adulthood. No significant association between obesity and maternal GDM was observed among female participants (RR = 0.97, 95% CI: 0.71-1.33).
The association of GDM with offspring obesity from late childhood through early adulthood may differ by sex; a significant association was observed among male but not female offspring.
动物数据表明，宫内环境改变会导致肥胖出现性别二态性编程，但妊娠期糖尿病（GDM）对人类后代肥胖的特定性别风险的纵向影响尚不清楚。
我们对来自“今日成长研究”的 15009 名美国个体（女性 7946 名，男性 7063 名）进行了前瞻性分析，这些个体从 1996 年（9-14 岁）开始随访，一直随访到 2010 年。通过验证过的问卷获取身高和体重数据，以获得不同年龄的体重指数（BMI）。使用国际肥胖特别工作组和世界卫生组织的标准，根据儿童期（<18 岁）和成年期（≥18 岁）定义肥胖。通过母亲自报的问卷识别 GDM 暴露情况。使用多变量对数二项式回归模型和广义估计方程，考虑到同一家庭内的聚类，估计相对风险（RR）。
患有 GDM 的母亲所生的男婴的 BMI 高于未患 GDM 的母亲所生的婴儿，且肥胖风险增加；所有年龄组的调整后 RR（95%CI）为 1.47（1.11-1.95），晚期儿童为 1.59（1.05-2.41），青春期为 1.48（1.06-2.06），成年早期为 1.39（1.00-1.94）。在女性参与者中，肥胖与母亲 GDM 之间没有显著关联（RR=0.97，95%CI：0.71-1.33）。
GDM 与儿童晚期到成年早期后代肥胖的关联可能因性别而异；在男性后代中观察到显著关联，而在女性后代中则没有。
