Impact of maternal fasting blood glucose in pregnancy on body composition, anthropometric, and metabolic outcomes in newborns and 3-Year-Old offspring: results from the lifestyle in pregnancy and offspring study.

backgroundGestational diabetes mellitus is becoming increasingly prevalent and has been associated with adverse outcomes for both mothers and their children. Prenatal exposure to maternal obesity and hyperglycemia has been associated with higher risks of macrosomia, neonatal hypoglycemia and later metabolic disorders. However, because diagnostic fasting glucose thresholds vary internationally, it remains unclear how different cut-offs, as well as fasting glucose as a continuous measure, relate to offspring growth and metabolism. This study investigated whether maternal fasting glucose predicts offspring body composition, anthropometry and metabolic outcomes at birth and at 3 years.

methodsThe analysis used data from the Lifestyle in Pregnancy (LiP) study and its 3-year follow-up, the LiPO study. Of 301 women in LiP, 157 participated in LiPO, and 75 children had DXA assessments. Maternal fasting plasma glucose at 28 weeks was analyzed continuously and across thresholds from 4.6 to 5.8 mmol/L using regression models adjusted for maternal age and pre-pregnancy BMI. Offspring outcomes included birth weight, birth weight z-score, BMI z-score, fat and fat-free mass, lipids and blood pressure.

resultsHigher maternal fasting glucose was associated with a higher birth weight z-score. At 3 years, no significant associations were found for BMI z-score or metabolic markers, although small, non-significant trends toward higher fat and fat-free mass were observed. Threshold analyses showed that glucose ≥ 5.6 mmol/L predicted higher birth weight and increased large-for-gestational-age risk, and glucose ≥ 5.3 mmol/L predicted higher cord c-peptide. No threshold was linked to metabolic differences at 3 years.

conclusionMaternal hyperglycemia was associated with adverse neonatal outcomes but not with offspring adiposity at 3 years. Longer-term follow-up, including the ongoing 15-year LiP data, is needed to determine whether mild maternal hyperglycemia has later metabolic consequences.

trial registrationBoth the LiP and LiPO studies received approval from the Regional Ethics Committee of Southern Denmark (S-20070058) and were registered with the Danish Data Protection Agency. The LiP study was registered at www. CLINICALTRIALS: gov (NCT00530439) with a registration date of September 13, 2007. The LiPO follow-up, initiated in 2010 while the LiP study was still ongoing, was registered at www. CLINICALTRIALS: gov (NCT01918319) to compare offspring of LiP participants.