Scientists at Tianjin Women’s and Children’s Health Centre (China), working in collaboration with researchers from Asia, Europen, African, and North and South American, have found that gestational diabetes mellitus (GDM) is associated with increased odds of offspring obesity.
The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), published in Diabetologia, shows that GDM raises childhood risk of obesity at age nine to 11 years in more than 4,700 children studied.
Researchers knew that children born to women with gestational diabetes, which affects up to 28 per cent of pregnancies, are at increased risk of obesity. But, to date the majority of research has focused on high-income countries, with limited data for children from multiple regions of the world.
The multinational study, led by Pei Zhao, is the first to evaluate the association between GDM and childhood obesity using such a widespread collection of data from low to high-income countries.
Zhao and his/her colleagues examined the cases of 4740 children aged nine to 11 years from Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South African, the United Kingdom, and the United States.
The cross-sectional study used the American Diabetes Association (ADA) and World Health Organization (WHO) diagnosing criteria as well as three indicators of childhood obesity (BMI, waist circumference, and body fat) to conduct their experiment.
The results first revealed that children aged nine to 11 born to mothers who had GDM had significantly higher prevalence of general obesity (18.4% vs 12.0%), abdominal obesity (16.0% vs 9.6%), high body fat (12.1% vs 7.9%) and high mean birth weight (3415 g vs 3274 g) compared with those of mothers without GDM.

Furthermore, the authors reported that they found an association between GDM and increased odds of general childhood obesity and abdominal obesity in the population studied across the 12 countries, but the latter is especially on the rise among children from high-income countries.
The overall prevalence of GDM around the world was 4.3 per cent but ranged from 1.9 per cent in the UK and China to 8.8 per cent in Portugal.
Adjustments to the findings were made for other factors including maternal age at delivery, maternal education, infant feeding mode, gestational age, number of younger siblings, child diet pattern scores, physical activity, sleeping time, sedentarism, age, sex, and birth weight. The findings were, however, only partially independent of current maternal body mass index (BMI).
Although the mechanisms responsible for increased obesity risk in these children are still unclear, the research team has been able to determine that exposure to GDM is associated with excess fetal growth in utero (due to an increase in fetal mass and alterations in fetal hormone levels) and results in elevated hyperglycemia, hyperinsulinemia, and elevated synthesis of – the satiety hormone – leptin in offspring.
Some research also suggest that GDM may cause an epigenetic alteration in the fetal genome which influences the expression of metabolic genes regulating, for example, the accumulation of body fat.

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