Gestational Glucose Intolerance and Risk of Obesity in Childhood and Adolescence

Abstract Objective An association between in utero exposure to gestational glucose intolerance ([GGI], abnormal glucose screening without gestational diabetes), and offspring obesity has not been consistently observed. Methods In a retrospective cohort, we studied the risk of obesity (body mass index [BMI] > 95th percentile), in 2-5, 6-10, and 11-18-year-olds exposed to varying degrees of maternal glycemia in utero: normal glucose tolerance (NGT), GGI (0 abnormal glucose values, GGI-0, or 1 abnormal value, GGI-1) or gestational diabetes (GDM >2 of 4 abnormal values). We used generalized estimating equations for logistic regression to estimate odds ratios for obesity in each glycemic category compared to NGT, adjusting for maternal age, parity, insurance, race/ethnicity, marital status, infant sex, gestational age, and gestational weight gain. A second model additionally adjusted for maternal 1st trimester BMI. Results We included 27,876 children and adolescents from 23,334 (83.7%) NGT pregnancies, 3,413 (12.2%) GGI pregnancies, and 1,129 (4.1%) GDM pregnancies. The prevalence of obesity was 13.5% at age 2-5, 20.3% at age 6-10, and 23.4% at age 11-18. Those exposed to GGI-1 and GDM had increased odds of obesity compared to NGT. Adjusting for maternal BMI attenuated this association in all age and glycemic exposure groups, but it remained significantly elevated in 6–10-year-olds exposed to GDM (odds ratio (OR): 1.21, 95%CI [1.01, 1.46] and 11-18-year-olds exposed to GGI-1 and GDM (GGI-1 OR: 1.44 [1.14, 1.81]; GDM OR: 1.28 [1.03, 1.59]). Conclusion Older children and adolescents exposed to GGI-1 and GDM in utero have a higher risk of obesity than those born to NGT pregnancies, even after accounting for maternal BMI.