Northwestern University Feinberg School of Medicine, Chicago, IL.
The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Diabetes Care. 2019 Mar;42(3):381-392. doi: 10.2337/dc18-2021. Epub 2019 Jan 7.
This study examined associations of maternal glycemia during pregnancy with childhood glucose outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) cohort.
HAPO was an observational international investigation that established associations of maternal glucose with adverse perinatal outcomes. The HAPO Follow-up Study included 4,832 children ages 10-14 years whose mothers had a 75-g oral glucose tolerance test (OGTT) at ∼28 weeks of gestation. Of these, 4,160 children were evaluated for glucose outcomes. Primary outcomes were child impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Additional outcomes were glucose-related measures using plasma glucose (PG), A1C, and C-peptide from the child OGTT.
Maternal fasting plasma glucose (FPG) was positively associated with child FPG and A1C; maternal 1-h and 2-h PG were positively associated with child fasting, 30 min, 1-h, and 2-h PG, and A1C. Maternal FPG, 1-h, and 2-h PG were inversely associated with insulin sensitivity, whereas 1-h and 2-h PG were inversely associated with disposition index. Maternal FPG, but not 1-h or 2-h PG, was associated with child IFG, and maternal 1-h and 2-h PG, but not FPG, were associated with child IGT. All associations were independent of maternal and child BMI. Across increasing categories of maternal glucose, frequencies of child IFG and IGT, and timed PG measures and A1C were higher, whereas insulin sensitivity and disposition index decreased.
Across the maternal glucose spectrum, exposure to higher levels in utero is significantly associated with childhood glucose and insulin resistance independent of maternal and childhood BMI and family history of diabetes.
本研究旨在探讨妊娠期间母体血糖与 Hyperglycemia and Adverse Pregnancy Outcome（HAPO）队列中儿童血糖结局的关系。
HAPO 是一项观察性国际研究，旨在确定母体血糖与不良围产期结局的关系。HAPO 随访研究纳入了 4832 名年龄在 10-14 岁的儿童，这些儿童的母亲在妊娠约 28 周时进行了 75g 口服葡萄糖耐量试验（OGTT）。其中，4160 名儿童接受了血糖结局评估。主要结局为儿童糖耐量受损（IGT）和空腹血糖受损（IFG）。其他结局包括儿童 OGTT 中血浆葡萄糖（PG）、A1C 和 C 肽的血糖相关指标。
母体空腹血糖（FPG）与儿童 FPG 和 A1C 呈正相关；母体 1 小时和 2 小时 PG 与儿童空腹、30 分钟、1 小时和 2 小时 PG 以及 A1C 呈正相关。母体 FPG、1 小时和 2 小时 PG 与胰岛素敏感性呈负相关，而 1 小时和 2 小时 PG 与处置指数呈负相关。母体 FPG 与儿童 IFG 相关，而母体 1 小时和 2 小时 PG 与儿童 IGT 相关，但与 FPG 不相关。所有关联均独立于母体和儿童 BMI。随着母体血糖水平的升高，儿童 IFG 和 IGT 的发生率以及时间相关的 PG 指标和 A1C 升高，而胰岛素敏感性和处置指数降低。
在母体血糖谱的各个范围内，宫内暴露于较高水平的血糖与儿童血糖和胰岛素抵抗显著相关，独立于母体和儿童 BMI 以及糖尿病家族史。
