Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Department of Nutritional Sciences, University of Toronto, Toronto, Canada.
Pediatr Diabetes. 2020 Nov;21(7):1150-1158. doi: 10.1111/pedi.13104. Epub 2020 Sep 9.
The evolution of increased adiposity and cardiometabolic risk in offspring exposed to maternal gestational diabetes (GDM) is not well understood.
(a) To evaluate the impact of in utero exposure to GDM and maternal weight status on homeostasis model assessment of insulin resistance (HOMA-IR) in the offspring longitudinally from 1 to 3 years of age and (b) to compare body mass index (BMI) and HOMA-IR in GDM and non-GDM exposed offspring at 1 and 3 years of age.
A prospective cohort of children born to mothers with and without GDM underwent metabolic characterization between birth and 3 years of age.
In the overall cohort, weight gain between birth and 3 years of age was positively associated with HOMA-IR (β = 0.1491, P = .02), independent of maternal weight status. HOMA-IR was not different between GDM and non-GDM exposed children from 1 to 3 years of age; however, BMI z score was greater in GDM exposed children at 3 years of age. Among non-GDM exposed children, male sex predicted a 35.1% lower HOMA-IR (P = .03). In GDM exposed offspring, a 1 unit increase in maternal insulin sensitivity predicted a 20.8% decrease in HOMA-IR (P = .002).
Overall, weight gain in the first 3 years of life was positively associated with HOMA-IR, while insulin sensitivity of mothers with GDM negatively predicted HOMA-IR in the offspring. Our findings indicate the need to target weight trajectories in early life, as well as maternal factors during gestation to improve metabolic outcomes in the offspring, particularly those exposed to GDM.
在母体妊娠糖尿病（GDM）暴露下，后代的肥胖和心脏代谢风险的增加的演变过程还不太清楚。
（a）评估宫内暴露于 GDM 和母亲体重状况对后代从 1 岁到 3 岁的稳态模型评估胰岛素抵抗（HOMA-IR）的影响；（b）比较 1 岁和 3 岁时 GDM 和非 GDM 暴露后代的体重指数（BMI）和 HOMA-IR。
一项前瞻性队列研究，纳入了患有和未患有 GDM 的母亲所生的儿童，在出生到 3 岁期间进行了代谢特征分析。
在总体队列中，出生到 3 岁期间的体重增加与 HOMA-IR 呈正相关（β=0.1491，P=0.02），与母亲体重状况无关。1 岁到 3 岁时，GDM 和非 GDM 暴露儿童的 HOMA-IR 没有差异；然而，GDM 暴露儿童的 BMI z 评分在 3 岁时更高。在非 GDM 暴露的儿童中，男性预测 HOMA-IR 降低 35.1%（P=0.03）。在 GDM 暴露的后代中，母亲胰岛素敏感性增加 1 个单位，HOMA-IR 降低 20.8%（P=0.002）。
总的来说，前 3 年的体重增加与 HOMA-IR 呈正相关，而 GDM 母亲的胰岛素敏感性预测了后代的 HOMA-IR 降低。我们的研究结果表明，需要针对生命早期的体重轨迹以及妊娠期间的母亲因素进行干预，以改善后代的代谢结果，尤其是那些暴露于 GDM 的后代。
